The document provides information about various substances that can lead to addiction. It defines addiction according to several organizations and lists diagnostic criteria. It describes the neurological, genetic, psychosocial and environmental factors that influence addiction. It then goes on to explain different categories of addictive substances like narcotics, depressants, stimulants, hallucinogens, cannabis and others. For each category, it lists examples and their effects. It also discusses in detail alcohol and opioid addiction, withdrawal symptoms, effects on the body systems and common co-morbidities.

1. ADDICTION
JATISH SHAH
ADDICTION COUNSELLOR
SHAH BAUG, NO: 1, GROUND FLOOR, GARDEN LEVEL,
BYRAMJI GAMADIA ROAD, OFF: DR. G. DESHMUKH MARG,
BEHIND PRABHU KUNJ (BUILDING), MUMBAI 400 026.
CONTACT NUMBER: +91 98195 33496
E.MAIL I.D.: shah_jatish@hotmail.com

3. The National Council on Alcohol and
Drug Dependence (U.S.A) defines
alcoholism this way:
"Alcoholism is a primary, chronic disease with
genetic, psychological, and environmental
factors influencing its development and
manifestations. The disease is often
progressive and fatal. It is characterized by
impaired control over drinking, preoccupation
with the drug alcohol, use of alcohol despite
adverse consequences, and distortion in
thinking, most notably denial."

4. W.H.O. defines that Drug addiction is a stage of periodic
and chronic intoxication detrimental to the individual and to
society, produced by the repeated consumption of a drug
(natural or synthetic). Its characteristics include:
1. An overpowering desire, a need (compulsion) to
continue taking drugs and to obtain it by any means.
2. A tendency to increase the dose.
3. A psychic (psychological) and sometimes a physical
dependence on the effects of the drugs.
From the above definition it is evident that physiological and
psychological need of the drug is inherent in drug addiction.
The need is so overwhelming that the craving for the
addiction forces the individual to acquire it by any means.

5. DSM-IV-R gives the following seven criteria for addiction
1. Tolerance.
2. Withdrawal.
3. Increased consumption.
4. Persistent desire to control substance use
5. Great deal of time is spent in consuming the substance
6. Important occasions are ignored.
7. Continued consumption despite knowing the
negative consequences.
At least three of the above criteria should have occurred
together in the same period of 12 months.
I.C.D – 10 has similar diagnostic criteria.

6. Addiction is a Primary Disease and is
recognized as such by the W.H.O.
Alcoholics / Narcotics Anonymous state
that Alcoholism / Addiction is a tri-faceted
disease comprising of a
- Physical Craving
- Mental Obsession
- Spiritual Bankruptcy

7. The demand that the physical being makes when
deprived of the addictive substance.
This is best seen during “Withdrawals” symptoms
which occur when the chemically dependent
victim is deprived of the substance or behavior.
- Tremors, Abdominal Cramps, Loose motions,
Joint Pains, Cold Sweating, Inability to sleep
fitfully, Loss of Appetite, Restlessness,
Disorientation.
In extreme cases – Delirium Tremens, Rum Fits
and Hallucinations.

8. When not actually using, the chemically dependent
person is thinking about using the addictive
substance/behavior of his choice.
He thinks about, plans, dreams and looks
forward to using the substance/behavior of
his choice.
All his plans will revolve around the
substance/behavior that he is addicted to.

9. This is the inability to relate to –
SELF – Self hating, low self-worth.
GOD – a transactional relationship.
OTHERS – Isolation and Loneliness.
The inability to express ones self
openly, honestly and fearlessly.
Poor communication skills.

10. The disease of addiction, as per AA / NA is:
Progressive – If not treated it can only get
worse with time.
Incurable – There is no cure. However,
it can be arrested.
Predictable – If not arrested, insanity or/&
death is definite.

11. NEUROBIOLOGICAL FACTORS.
A.Brain reward mechanism – repeated use of
substances triggers off reward area of the brain.
B.Neuro-regulator system – reinforcement of
substance use is mediated by raised dopamine
release.
C.Craving – has been linked to change in
neurotransmitters.
D.Membrane studies – substance induced

12. Psycho-dynamic factors.
A. Oral fixation and overly punitive super ego.
B. Sense of power and raised self-esteem.
C. Reduce tension, anxiety and psychic pain.
Socio-cultural factors.
A. Social settings – e.g: college dorms, military
barracks.
B. Cultural differences – e.g: Asians tend to
drink less.

13. Behaviour & learning theories
Re-inforcement of feeling of well-being and
euphoria, reduction of fear, anxiety, tension
through substance use.
Genetic factors.
Genetic predisposition in an individual is
supported by various monozygotic and twin
studies

14.  + Family history of alcoholism,
addiction or antisocial behavior
 Family modeling of substance use
behaviors
 Poor parenting skills, family
dysfunction
 Permissive attitude toward teen use
 ↑ household conflict, family chaos
 Child abuse or neglect (physical,
sexual)

15. • ↓ interest in school and achievement,
early academic failure
• ↓ self-esteem
• ↓ religious activity
• Rebelliousness and social alienation
• Early antisocial behavior, delinquency
• Psychopathology, especially depression or
mood disorders.
• Sexual dysfunction or sexual deviance.
• Early ↑ risky behaviors: ATOD*, sex
* Alcohol, Tobacco, Other Drugs

16.  Perceived peer ATOD use, best
friend’s ATOD use
 Ethnic or cultural influences
 Community/neighborhood
deterioration/ disorganization
 Easy access, early access
 Advertising and media portrayal

17.  NARCOTICS
 DEPRESSANTS
 STIMULANTS
 HALLUCINOGENS
 CANNABIS
 OTHERS

18. These are drugs that anaesthetize or
neutralize pain. They contain opium or
substances that are similar to Opium.
 Opium (Afeem).
 Morphine.
 Codeine (Corex, Phensidyl)
 Heroin (Diacetylmorphine, Smack,
Brown Sugar, Gard) (Second most
abused)
 Meperidine (Demerol, Pethidine)
 Methadone
 Others (Lomotil /Lomofen)

19. These are drugs that slow down the CNS.
 Alcohol (The KING of all addictions)
 Barbiturates (Amytal, Barbital, Seconal,
Phenobarbital)
 Benzodiazepines (Librium, Valium, Alam,
Alprax, Lopez, Calmpose, Ativan, Trika,
Restyl, Etc)
 Methaqualone (Mandrax, Mandy)
 Other depressants (Placidyl)
(Alcohol and tranquilizers/sedatives are
substitutive addictive substances)

20. These are drugs that stimulate the CNS.
 Cocaine (Crack).
 Amphetamines (Dexerine, Biphetamine)
 Phenmetrazine
 Methylphenidate (Ritalin)
 Dextroamphetamine

21. These are drugs that alter perception of
reality. Time and space get warped.
Hallucinogens induce a state of CNS excitation
and central autonomic hyperactivity,
manifested as changes in perception and
mood (usually euphoric, sometimes
depressive).
 LSD (Acid, Blotting paper, Cork).
 Amphetamine Variants ( MDMA, Ecstasy)
 Phencyclidine Phosphate (PCP)
 Others (Magic Mushrooms / Psilocybin)

22. These drugs create a long term change
in personality and can lead to cannabis
insanity. Delta Tetrahydrocannabinol
(THC) is the active ingredient in
Cannabis.
 Marijuana (Grass, Weed, Ganja, Bhang).
 Hashish (Hash, Charas).
 Hashish Oil (Hash Oil).

23.  Nicotine
 Inhalents
 Date Rape Drugs
(which may fall under one of the above
categories, but are mentioned seperately
because they are newer and their
function in society has changed)

25. POPPY POD
OPIUM
HEROIN
OPIUM AND DERIVATIVES

26. OPIUM USER

30.  Opioid receptors.
 Endogenous opioids.
 Analgesic.
 Effects on various body systems.

31. THE WITHDRAWAL SYNDROME IS SELF-LIMITED AND,
ALTHOUGH SEVERELY DISCOMFORTING, IS NOT LIFE
THREATENING.
The withdrawal syndrome from an opioid generally includes
 Symptoms and signs of CNS hyperactivity.
 Severity of the syndrome increases with the size of the
opioid dose and the duration of dependence.
 Symptoms appear as early as 4 to 6 h after withdrawal
and, for heroin, peak within 36 to 72 hrs.
 Anxiety and a craving for the drug.
 Increased resting respiratory rate (>16 breaths/min)
 Yawning, perspiration, lacrimation, and rhinorrhea.
 Other symptoms include mydriasis, piloerection
(gooseflesh), tremors, muscle twitching, hot and cold
flushes, aching muscles and anorexia.

32.  IV fluids.
 Clonidine.
 Dextropropoxyphene.
 Buprenorphine.
 Benzodiazepines.
 Symtomatic management.

33.  Pulmonary
 Hepatic
 Musculoskeletal
 Immunologic
 Neurologic
 Others

34. Opioid analgesics (sometimes termed
narcotic analgesics) are either derived from
the opium poppy or manufactured
synthetically. They include heroin,
morphine, methadone, meperidine and
codeine. They are used medically primarily
for the relief of pain, although they are also
employed to suppress a cough, and
occasionally in the treatment of severe
diarrhea. Their dependence liability is
generally high.

35. Favoured drugs include the analgesics
meperidine, oxycodone and codeine, and
the cough suppressants hydromorphone
and hydrocodone (in Corex and Phensidyl
cough syrups).
Cough suppressants ( Corex, Phensidyl,
Codiene Linctus, Etc) are very widely used
by the youngster of today and, tragically,
physicians to prescribe these as they
“appear” harmless and offer quick relief.

36. Codeine can be injected, or taken orally
depending on the form in which it is –
Liquid or Tablet.
It is used for pain relief and euphoria
but it can lead to drowsiness / nausea,
constipation, confusion, sedation,
respiratory depression and arrest,
tolerance, addiction, unconsciousness,
coma and even death.

37. Oxycodone HCL and Hydrocodone
bitartrate are also used for the feeling of
well being that they generate.
Generally found in the form of cough
syrups, they have the same effect as
codeine

39.  90% population consumes alcohol at some
point of time in their lives.
 30% - temporary alcohol related problems.
 10% - alcohol dependence.
 25-30% - alcohol abuse.
 45% - co-morbid depression.
 14% - ASPD traits.

40.  Type I and Type II.
 Jellinek’s classification – alpha, beta, gamma,
delta & epsilon.
 Early onset & Late onset.

41. Alcohol is a highly lipid soluble and is
largely absorbed in the small intestine.
Pharmacokinetics:
Ethanol Acetaldehyde Acetic Acid
Alcohol Acetaldehyde
dehydrogenase dehydrogenase
Exits through
Urine/Sweat.

42. The clinical presentation depends upon
the Blood Alcohol Concentration (BAC).
BAC (mg/dl) Clinical presentation
30 Attention difficulties,
Euphoria.
50 Co-ordination problems.
100 Ataxia, Impaired judgment.
200 Confusion, Consciousness.
> 400 Anaesthesia, Coma?, Death?.

43.  Apart from these symptoms, the
patient may
present with a fall and have head
injury.
 Occasionally, presented are:
Delirium.
Pathological intoxication.

44. In withdrawal, an alcoholic may present:
 Delirium tremens – abnormal perception,
agitation,
terror,
autonomic instability,
confusion, auditory &
visual
hallucinations.

45. Other symptoms that may be
presented are:
 Restlessness.
 Tremulousness.
 Withdrawal seizures.
 Lack of sleep.
 Tactile sensations.

47.  Central Nervous System.
 Peripheral Nervous System.
 Gastro-intestinal Tract.
 Cerebrovascular and Cardiovascular
system.
 Haematological effects.
 Cancer.
 Metabolism.

48.  Persisting dementia.
 Psychotic disorders.
 Persisting mood disorders.
 Persisting amnestic disorders.
 Persisting anxiety disorders.
 Other behavioural and sexual
disorders.
 Pathological intoxication.
 Alcohol withdrawals
 Delirium tremens

49.  Routine lab investigations
 Specific investigations
 GGTP / Liver function tests.
 Serum Ammonia.
 MCV.
 Uric acid.
 Triglycerides.
 USG
 Carbohydrate deficient transferrin (CDT).

50. BARBITURATES
The barbiturates have been used since
the early 1900s for epilepsy. Although
their dangers were universally recognized
- severe respiratory depression, high-
dependence liability and life-threatening
withdrawal reactions, safer alternatives
did not exist until recently.

51. The short-acting barbiturates such as
Secobarbital are still used illicitly, since
they take effect quickly and produce the
most euphoria. They are often
administered to enhance the effects of
other sedative-hypnotics or to terminate
the unpleasant effects of a long stimulant
binge.

52. HYPNOTICS
The many prescription drugs that slow the
activity of the central nervous system are
called sedative-hypnotics. They include the
barbiturates, general anesthetics, anti-
anxiety tranquillizers (eg,
benzodiazepines) and a number of non-
barbiturate sedatives. These substances
are prescribed to relieve anxiety, to induce
sleep, to prevent or treat epileptic
seizures, or to produce surgical
anesthesia. All can create dependence in
some individuals.

53. The benzodiazepines (13 different kinds are being sold in
India)
 Diazepam
 Chlordiazepoxide
 Oxazepam
 Flurazepam
 Midazolam
 Triazolam
 Alprazolam
 Lorazepam
 Nitrazepam
 Clonazepam
 Estizolam
 Flunitrazepam
Physicians agree that these drugs are safe for short-
term uses (i.e, less than 4 weeks), but there is a high
abuse potential and dependence.

54. The effects of Benzodiazepines are
sedation, Drowsiness /dizziness

55. Methaqualone known as Mandrex or
Mandy. This has been withdrawn from
the market. However, it is available as a
street drug and contains a lot of
impurities. The effect seen on consuming
Mandrex are euphoria/depression, poor
reflexes, slurred speech, coma.

56. Fentanyl is used for pain relief, however
it is abused for the feeling of euphoria
that it creates.
It can cause drowsiness/nausea,
constipation, confusion, sedation,
respiratory depression and arrest,
tolerance, addiction, unconsciousness,
coma, death.

58.  Psychological dependence leading to
profound psychological addiction,
produced by high doses of cocaine, which
can cause euphoric excitement.
 Tolerance occurs, but physical
dependence has not been confirmed; no
stereotypical withdrawal syndrome occurs
when the drug is discontinued. However,
the tendency to continue taking the drug
is strong.

59. short acting drug – repeated use leading to:
 Toxic effects, such as tachycardia, hypertension,
mydriasis, muscle twitching, sleeplessness, and
extreme nervousness.
 Hallucinations, paranoid delusions, and aggressive
behavior can develop. Pupils are maximally dilated
 Sympathomimetic effect increases heart and
respiration rates and BP.
 Overdose may produce tremors, convulsions, and
delirium. Death may occur due to arrhythmias and
cardiovascular failure.

61. “Snorting” Coke

62. Psychological dependence produced by
amphetamine causes elevated mood;
increased wakefulness, alertness,
concentration and physical performance
and a feeling of well-being.

65. Known on the streets as chalk, crank,
crystal, fire, glass, go fast, ice, meth,
speed, it can cause aggression, violence,
psychotic behavior/memory loss, cardiac
and neurological damage, impaired
memory and learning, tolerance, addiction.
Crystal Meth is the latest entrant in
this field.

67. Known on the streets as Adam, Clarity, Ecstasy,
Eve, Lover's speed, Peace, STP, X, XTC, it can
cause mild hallucinogenic effects, increased
tactile sensitivity, empathic feelings/impaired
memory and learning, hyperthermia, cardiac
toxicity, renal failure, liver toxicity, etc, etc.

69. A new and very dangerous drug. This, too
has found its way into India and instances of
abuses are beninning to be seen
The chemical n-methyl-1-phenyl-propan-2-
amine is called methamphetamine,
methylamphetamine, or desoxyephedrine.
The shortened name is simply 'meth'. When
it is in its crystalline form, the drug is called
crystal meth, ice, Tina, or glass.

70. What Are the Effects of Methamphetamine Use?
This is a list of effects associated with pure
methamphetamine use. Because of how it's made, crystal
meth is never pure, so the dangers associated with taking
the street drug extend beyond these effects.
Common Immediate Effects
 Euphoria
 Increased energy and alertness
 Diarrhea and nausea
 Excessive sweating
 Loss of appetite, insomnia, tremors, jaw-clenching
 Agitation, irritability, talkativeness, panic, compulsive
fascination with repetitive tasks, violence, confusion
 Increased libido
 Increased blood pressure, body temperature, heart rate,
blood sugar levels, bronchodilation
 Constriction of the walls of the arterties
 In pregnant and nursing women, methampetamine
crosses the placenta and is secreted in breast milk

71. Effects Associated with Chronic Use
 Tolerance (needing more of the drug to get the
same effect)
 Drug craving
 Temporary weight loss
 Withdrawal symptoms including depression and
anhedonia
 "Meth Mouth" where teeth rapidly decay and fall
out
 Drug-related psychosis (may last for months or
years after drug use is discontinued)

73. Yaba is a combination of
methamphetamine (a powerful and
addictive stimulant) and caffeine. Yaba,
which means crazy medicine in Thai, is
produced in Southeast and East Asia. The
drug is popular in Asian communities in
the United States and increasingly is
available at raves and techno parties.
It has made its entry into India
through Bangladesh and Burma

75.  Rapid heart rate, increased blood pressure, and
damage to the small blood vessels in the brain
that can lead to stroke. Chronic use of the drug
can result in inflammation of the heart lining.
Overdoses can cause hyperthermia (elevated
body temperature), convulsions, and death.
Individuals who use Yaba also may have
episodes of violent behavior, paranoia, anxiety,
confusion and insomnia.
 Although most users administer Yaba orally,
those who inject the drug expose themselves to
additional risks, including contracting HIV
(human immunodeficiency virus), hepatitis B and
C, and other blood-borne viruses.

76. CANNABIS

77.  Smoked cannabis produces a dreamy
state of consciousness in which ideas
seem disconnected, unanticipated, and
free-flowing. Time, color, and spatial
perceptions may be altered.
 In general, a feeling of well-being and
relaxation (a "high") results.
 Tachycardia, conjunctival injection, and
dry mouth occur regularly.
 Panic reactions have occurred,
particularly in naive users, but have
become unusual as the culture has
become more familiar with the drug.

78.  Communicative and motor abilities are
decreased, depth perception and tracking
are impaired, and the sense of timing is
altered--all hazardous in certain
situations (eg, driving, operating heavy
equipment).
 Schizophrenic symptoms may be
exacerbated by marijuana, even in
patients being treated with antipsychotic
drugs (eg, chlorpromazine).
 Appetite often increases.
 Cannabis induced psychosis is common
and cannabis induced lunacy can follow in
the case of daily users.

79. The “high” felt by a marijuana smoker is a very
unique conglomeration of feelings, and there are
only two known sources for the substances which
activate the neuroreceptor for THC. The first source
is our own brains, which produce a neurochemical
very similar to THC called anandamide. The second
source for this substance is the cannabis plant from
which comes marijuana.

80.  Unfortunately, there are negative side effects
that occur from using marijuana. Some of these
include frequent respiratory infections,
impaired memory, increased heart rate,
impaired learning, panic attacks and
physical dependence on the substance.
Additionally, if used during the first month of
breast feeding, infants can suffer from impaired
motor development. Marijuana may produce
blissful effects in the minds of those who use it,
but its side effects are far from blissful.

81. Research has shown that THC changes the way in
which sensory information is transmitted to the
brain and the way that the hippocampus acts upon
the information. The hippocampus is a component
of the limbic system that is critical for learning,
memory and the integration of emotions,
motivations and sensory experiences. THC has
been shown to suppress the neurons involved
in information processing by the
hippocampus, and it has also been shown
that learned behaviors (which depend on the
hippocampus to “stick” in the brain) also
deteriorate.

82.  A person who smokes marijuana on a regular
basis may suffer from many of the same
respiratory problems that tobacco smokers
have. These people may cough daily and have
excess phlegm, may have symptoms of chronic
bronchitis and much more frequent chest colds.
 Continual smoking of marijuana can lead to
abnormal functioning of the lungs due to
tissue damage caused by marijuana smoke.
Additionally, the amount of tar inhaled by
marijuana smokers is three to five times more
than tobacco smokers, which can lead to further
lung damage.

83. Smoking marijuana while taking other drugs (both
legal and illegal) can lead to a sharp increase in
heart rate and blood pressure, which can
stress the cardiovascular system and risks
overload and potential heart failure.

84. The Effects on Men
In addition to providing pleasurable effects, marijuana can
also affect parts of the brain responsible for sex and
growth hormones. In men, marijuana can decrease
testosterone, cause enlarged breasts and lead to a
decrease in sperm count and infertility.
The Effects on Women
As in males, marijuana also effects women’s hormones,
which can cause problems such as irregular menstrual
cycles, depression, an increased testosterone level and
the possibility for having children with moderate to
severe physical and mental deficiencies ranging from
learning disabilities to babies born with weak central nervous
systems.

85.  I.V. Fluids for supportive treatment
 Treatment of any medical complications.
 Treatment for co-morbidity, such as
Psychosis, Anxiety, Mood disorder, etc
 Counselling and psycho-education

88. TOBACCO
Nicotine is the substance in cigarettes along with
other harmful chemicals (approximately 4400)that
smokers become dependent on. Thus, nicotine
dependence is essentially dependence on tobacco
products – cigarettes, bidis, gutka, cigars, etc.
About 70% of smokers have acknowledged that
they desire to quit smoking but are unable to do
so. Of people who quit, 90% do so on their own,
but only about 3 to 4% successfully quit in any
given year.

89.  Nicotine is highly addictive. Nicotine
provides an almost immediate “kick”
 Addiction to nicotine results in withdrawal
symptoms when a person tries to stop
smoking - increased anger, hostility, and
aggression, and loss of social
cooperation. Persons suffering from
withdrawal also take longer to regain
emotional equilibrium following stress

90.  Inhalation of 4000+ noxious chemicals.
 43 of these are proven to be
carcinogens.
 Nicotine, Pyridine, Methyl Alcohol,
Ammonia, Formaldehyde, Carbon
Monoxide, Benzopyrene, Phenols,
Acetone, Arsenic, Formic Acid, Oxalic
Acid, Citric Acid, Acetic Acid, Hydrogen
Cyanide are some of the toxins that are
available in tobacco.
 One cigarette contains approximately 100
Mcg of Nicotine. 500 Mcg directly
injected would cause instant death.

91.  Nicotine is physically addictive and a
harmful intoxicant.
 Inhaled nicotine takes just 7 seconds to affect
the brain and the C.N.S.
 Tar – directly linked to cancer
 Carbon Monoxide has been used to commit
suicide in enclosed place.
 Hydrogen Cyanide was used to gas criminals
to death in U.S.A. once upon a time.
...And yet we happily consume these
chemicals thinking that the cigarette is
relaxing for us, is good for us, makes us
think better, etc.

92.  Lung cancer
 Coronary heart disease
 Chronic lung diseases – bronchitis/emphysema
 Gastric and duodenal ulcers
 Cirrhosis of the liver
 Various cancers – pancreas, stomach, kidneys,
prostrate, bladder, liver, gall bladder
 Cancers of the oral cavity – lips, mouth, tongue,
throat
 And many, many more.

93. CANCER CURES SMOKING

94.  Pharmacological treatment combined
with behavioral treatment, including
psychological support and skills training
to overcome high-risk situations, results
in some of the highest long-term
abstinence rates
 Nicotine chewing gum
 Transdermal patch
 Bupropion
 Varnecline Tartrate (Champix)
 Anti-depressants
 Mood stabilizers

95. Among teenagers, inhalants are used more
frequently than cocaine or LSD but less
frequently than marijuana or alcohol.
Inhalant use is particularly a problem
among children aged 12 and younger.
Inhalants are found in many common
household products.

96. ADHESIVES
•Airplane Glue
•Rubber Cement
•Polyvinyl Chloride Cement
AEROSOLS
•Spray Paint
•Hair Spray
CLEANING AGENTS
•Dry Cleaning Fluid
•Stain Remover
•Degreaser
SOLVENTS AND GASES
•Typing Correction
Fluid Thinner
•Nail Polish Remover
•Paint Thinner
•Acetone
•Cigarette Lighter Fluid
•Petrol Fumes
•Fuels

97. All inhalants cause stimulation, loss of
inhibition, headache, nausea or vomiting,
slurred speech, loss of motor coordination,
wheezing, unconsciousness, cramps,
weight loss, muscle weakness, depression,
memory impairment, damage to
cardiovascular and nervous systems.
Inhalants can lead to sudden death due to
arrhythmia and asphyxia.

98. KETAMINE induces a lack of awareness
to pain and to one's general surroundings,
leading to a scattered feeling or to a
feeling of detachment. Ketamine is usually
injected intravenously and may be
snorted as well.
Also known as Vitamin K, Special K, KO,
Horse (because it has veterinary use).
It is also a common “date rape” drug.

100. GAMMA HYDROXIBUTYRATE (GHB) is taken
by mouth. It is similar to Ketamine in its
effects.
GHB produces feelings of relaxation and
tranquillity. It may also cause fatigue and
feelings of being uninhibited.
Also known as “Easy Lay”, “Liquid Ecstasy”.
This is another “date rape” drug”

101. MAY GOD
HELP ADDICTS
WHERE EVER
THEY BE.
FOR IF THEY
DO NOT GET
HELP, THE END
IS INEVITABLE -
- INSANITY
AND / OR DEATH

102. THANK YOU!
…… JATISH SHAH.