A: Every single drug of abuse, including alcohol, can affect your personal appearance. In many instances, these changes to how you look can be permanent, shocking and embarrassing. Almost every single drug of abuse can cause someone to lose so much weight that they are malnourished and unhealthy. Drugs can affect your skin by making you look much older than you really are. This is probably due to the combination of poor sleep, stress and poor nutrition. Many of our patients in our Addiction Clinic are in their 20s, but look 10 years older. Drugs can also cause you to have very damaged teeth and gum disease. Users of methamphetamine have a much higher likelihood of gum infections, cavities and tooth loss than expected. This is called “meth mouth”. In other areas of personal appearance, hair thinning and hair loss can be accelerated by using drugs and alcohol. And some drugs, such as anabolic steroids or alcohol, will cause shrinkage of reproductive organs (testicles) and excessive growth of breasts in men – two examples of highly undesirable outcomes in personal appearance.

A: DMT, formally known as N,N-Dimethyltryptamine, is a hallucinogenic drug that when ingested can cause users to experience visual, auditory and bizarre experiences such as seeing oneself from afar, mixing up of senses (hearing smells, seeing tastes). This drug affects the serotonin system, a chemical system in the brain that is responsible for controlling mood, attention and sensory processing. Synthetic DMT can be smoked, snorted or ingested. At this point, little is known about long-term effects of DMT use in humans, but animal research has shown that there may be damage to the brain areas that control mood, cognition and problem-solving. Clinically, I have seen several patients who have used DMT just a few times and they still struggle with depression, anxiety and concentration several months later.

A: Ecstasy, otherwise known as "X", is classified both as a stimulant and a hallucinogenic drug. It affects many different parts of the brain, especially areas that control pleasure, mood, emotional control and interpretation of sights, sounds and smells. The main neurochemicals that Ecstasy impacts are serotonin and dopamine. In a nutshell, the drug alters levels of these neurochemicals dramatically, causing the brain to radically change how it processes information and sensations. Ecstasy users report that many of their senses are intensified and heightened, as if the volume or the color control on the television were turned up to maximum. Some users report hallucinations, where they see or hear things that are not actually there. Others report having intense emotional experiences where they begin to laugh and cry without any particular reason.

Recent scientific work has shown that Ecstasy causes significant damage to the brain, even after just a few administrations. For this reason, many patients who are addicted to Ecstasy say that, even when they are sober, they just don't feel like that they have returned to normal. Those addicted to Ecstasy often have to deal with long-term psychiatric problems such as depression, impairments in learning, anxiety, insomnia and difficulty controlling anger. Although more research is needed in this area, scientists are pretty certain that Ecstasy can cause permanent damage to the brain, especially to areas of learning, memory, attention and mood. Knowing this is even more important for young adults because their brains are still growing (up until mid-20s!) and Ecstasy can and will dramatically affect brain growth and development.

A: Muscle building steroids are a Frankenstein-like mish-mash of synthetic chemicals meant to replicate natural occurring hormones. Most muscle building steroids are illegal, because they are poorly studied and have a wealth of negative effects while taking them, and when coming off of them. Most medical steroids are prescribed and managed by a physician because of their powerful effects on the body and potential negative side effects. Muscle building steroids are not managed by a physician, but can still have the same negative side effects. These substances alter most facets of human development, especially in teens, and can lead to cardiovascular problems, skin and acne concerns, stunted physical growth, abnormal development of reproductive organs, and even death.

Yes, there are negative withdrawal symptoms to steroids, depending on what is taken - the best way to avoid these symptoms is not to use them, or to stick with natural supplements and healthy eating habits.

A: Yes, depending on the concentration of smoke in the air, the size of the room you are in, and the amount of time you spend in the vicinity of someone else smoking marijuana, you can be affected by the second-hand smoke. Depending on your particular physical make-up, you may retain traces of marijuana in your system for up to 30 days.

A: The long-term effects of smoking marijuana can be divided up into physical and emotional consequences. In terms of physical consequences, smoking marijuana is linked to many of the same problems as tobacco smoking (such as cough, phlegm and wheeze). Marijuana users usually inhale more deeply and hold their breath longer than tobacco smokers do, which further increases the lungs' exposure to carcinogenic smoke. Research has shown that the most common physical problems from smoking marijuana can be lung problems such as bronchitis and pneumonia. Some smokers report having chronic cough (an early sign of serious lung damage) just a few months after regular marijuana use.

Long-term emotional consequences can be highly variable. The most damaging one is probably the risk of developing a psychiatric illness such as depression, anxiety or other psychotic symptoms. Marijuana has never been shown to help these psychiatric problems over time and there is a mountain of research to show that if you smoke marijuana now, then your psychiatric problems are not likely to get better on their own - actually, they are more likely to get worse.

There is also clear evidence that smoking pot will affect your ability to learn, and function in school. Clearly this will have a huge impact on your life, from interfering with the kinds of jobs you want or getting into your first choice of college. From another perspective, marijuana can also cause you to reduce your motivation in life and to become more apathetic about things. In turn, this can also be just as damaging to life because it means missing out on important opportunities.

A: The scientific evidence shows that pot affects just about every part of your memory and the ability to learn. For instance, pot can make people more forgetful, have lower attention spans, and to show that marijuana use in high school or be less creative. There are now several studies college will result in lower grades and academic performance.

Additionally, those who smoke marijuana regularly are more likely to drop out of high school and also have alcohol-related problems. Marijuana is a powerful drug that can affect many different parts of the brain especially the parts that control learning and memory. Research has also shown that your brain is going through the most growth during the adolescent years - so if you smoke pot it can affect proper development of your brain, which could not only cause learning problems in high school, but also in the future.

A: Creatine is a dietary supplement that is popularly used by professional athletes and hopeful sports competitors who believe it is safe and will improve sports performance. Some research studies, mostly with young men, have shown that some individuals taking creatine for a short time can show improvement in specific types of exercise that use repeated short bursts of power. However, no studies have shown that creatine use improves maximal strength or aerobic exercise performance.

Keep in mind that just because something does not seem to have side effects does not guarantee it is safe. Although creatine is a natural product, this doesn't make it completely safe, since the large amount being used is not ?natural.' It is more natural to continue to rely on athletic ability, training, and dedication to determine sports performance.

Also keep in mind that creatine leads to noticeable weight gain within the first few days, probably from retaining water. Some research suggests that high-dose creatine use before or during exercise might have harmful effects on body fluid balance, so using creatine at these times is not recommended. People have reported creatine use to cause nausea, vomiting and/or diarrhea, as well as decreased kidney function, high blood pressure, and muscle cramps.

A: When your friend gives some of his pills to friends, he is putting himself and his friends at risk. Adderall is a stimulant medication usually used in a long-acting form to help treat attention-deficit/hyperactivity disorder. Your friend was probably prescribed Adderall to help him focus his thoughts and ignore distractions, so he can reach his full potential, but that is not happening when he gives his pills to someone else.

Teens often mistakenly believe that getting a medication by prescription means it is safe, so that it must also be safe to take for non-medical reasons or in larger doses. This is completely wrong and even that short-term high may be doing real harm to the brain and body.

A: One of the most common causes of death from drinking alcohol is alcohol poisoning. Binge drinking can be defined as drinking more than five standard drinks (four drinks for women) over two hours (A standard drink is usually thought as one beer, one shot of hard liquor, or one glass of wine).

Young adults who drink a lot a few times a year are just as likely to cause problems in their lives than those who drink everyday. Binge drinking especially puts people at risk to cause car accidents, sexual assaults, and other destructive behaviors. Teens who binge drink are also more likely to develop tolerance to alcohol (that is, they will need to drink more drinks to get the same effect).

Binge drinking also puts people at risk to develop alcohol poisoning. Many teens feel that alcohol is safe because it is legal and widely available. The truth is that over 100,000 people a year die from alcohol-related deaths. If people drink too much alcohol over one period they can die from it. The usual cause of death is brain damage to the parts of the brain that control breathing. Ask yourself: Is that how you want to end a fun night out?

A: Addiction is a brain disease. That means that there are physical changes in the brain that explain some of the behaviors seen in patients with addiction (such as preoccupation with drugs and loss of control over taking drugs). It also means that, sometimes, just having willpower and motivation is not enough to fight an addiction. Just like if you broke your leg or sprained your ankle, fighting it mentally would not be enough. In order to make sure that addiction is treated properly, it requires professional help.

Many teens with drug problems think they are weak because they continue to use drugs. But addiction is not a matter of being strong or weak - the strongest are the ones who are able to put aside their fears, shame, and guilt, and reach out for help.

Some people are able to control their drug use through willpower, but these people are not likely to have an addiction. For people who are clearly addicted to drugs, it will require more than just willpower to stop.

A: Yes, rehab (or substance abuse treatment) does really work and can be very helpful for those who struggle with addiction. Effective treatment will help a person work through their physical withdrawal from the drug, develop effective coping skills, and in some situations, provide a safe opportunity to practice those coping skills.

Treatment comes in many forms and the length of stay should be individually tailored to the needs of the person being treated. For those with less severe symptoms, individual counseling a few times a week may be beneficial. People with moderate symptoms may benefit from a program of several hours duration several times each week. Individuals who struggle with substance dependence, or addiction, benefit most from a safe environment, free of substances, where they can begin the recovery process.

Current research indicates that for those who struggle with addiction, treatment should last at least one year. That is not to say that they should be in a rehab facility for that length of time, but that they should maintain a connection to treatment for at least one year for the best results. However, recovery is a life-long process and regular participation in recovery meetings or support groups after treatment has also proven to be very successful in remaining drug-free.

A: Addiction is when you crave drugs and get to a point when you often find yourself using, thinking about or seeking out drugs. These cravings are extremely difficult to control. For someone who is truly addicted there is no motivation more powerful than the drug craving, and the person's life becomes centered around getting and using the drug.

Chemical dependency, or addiction, as defined by the American Psychological Association, is seen as a pattern of drug use, where the user experiences three (or more) of the following:

(1) tolerance, which means needing to use more of the same substance to get the same high;

(2) withdrawal symptoms from detoxing from alcohol or drugs (such as nausea, insomnia, anxiety, sweating, trembling);

(3) using more than what you intended;

(4) persistent desire to use, or unsuccessful attempts to quit;

(5) increasing time spent using or getting drugs;

(6) giving up important life activities due to using (like not going to school or quitting a job); and

(7) continuing to use despite knowledge of the problem's impact.

One of the best ways to determine if you are addicted, or if you have a drug problem, is to talk to a trained professional and ask for a confidential assessment. From that assessment, a professional will be able to help you understand your symptoms, and to find the right level of help you might need.

A: There are any number of reasons why someone will deny that he or she has a drug problem. Some reasons have to do with embarrassment or concealment due to real or perceived consequences (like getting punished at home or suspended from school). Some people are embarrassed that they have a problem that they feel that they cannot control. They may feel bad about the things that they have done while high or drunk.

There is also a lot of stigma associated with drug abuse. Being labeled a "drug abuser" may have any number of social and psychological consequences for the substance abuser, including lowering one's self-esteem, limiting one's social (e.g., being cut off from friends and family), educational (i.e., being expelled from school), or even occupational opportunities (e.g., not being hired at a local restaurant).

Many times, people don't want to admit that they have an addiction because it will mean having to give up something that they value or something they need to get by. But there are real repercussions if you don't admit to having a drug problem. You might be subject to more scrutiny by family, friends, or people in the community (e.g., police) that may result in social and legal consequences.

Also, a lot of people think they have their drug use "under control," but in most cases drugs gain control of you. And sometimes a friend, family member, or teammate is the one who sees the signs of trouble first.

A: It is unclear if your friend has an addiction. However, most health experts would say that drinking to the point of passing out is very dangerous and life threatening. As a friend, I would be very concerned too. There are a number of associated with drinking too much alcohol, including any number of risks such as drunk driving and physical harm. It's not always easy to see signs and symptoms related to alcoholism. While there is no single warning sign for alcohol abuse, some signs of a possible problem include:

• She gets drunk on a regular basis.
• She drinks when she is alone.
• She shows up at school drunk or she has skipped class to drink.
• She needs alcohol to have a good time or cope with everyday life.
• She plans for alcohol use in advance.
• She starts hanging out with new friends who will drink with her or can score for her.
• She lies about drinking.
• She pressures you or others to drink.
• She has broken plans with you, or showed up late, because she was drunk.
• She lacks interest in previously enjoyed activities or hobbies (e.g., sports, hobbies).
• She has driven a car while drunk or high.
• She borrows or steals money to buy alcohol.

A: You must be an awesome friend to be courageous enough to ask this question! Yes, I agree you should do something to help your friend. If your friend is being hurt or abused, it is important to get help for her as soon as possible. You can tell your friend that you are worried about her and her situation, and even ask her if she would like to go with you to talk to somebody. But even if she disagrees, it’s still important for you to talk to someone. You may want to start with talking to your parents or your school guidance counselor—any trusted adult that can help you start the process of helping your friend with her situation. From there, you and the trusted adult can work to get your friend the help she needs. Good luck!

A: The effects of alcohol withdrawal can vary significantly depending on how often a person drank, how much they drank, and how consistently they drank. Withdrawal can range from headaches and general lethargy - what many people refer to as a "hangover", to more dangerous physiological symptoms.

If you, or anyone you know, has a significant problem with alcohol and they are now trying to quit, it is very important to enlist the help of a trained professional. An experienced counselor, psychologist, or physician with training in substance abuse can help determine the extent of use, and the potential withdrawal symptoms, and then help the person formulate a plan to stop using in the most effective and healthy manner possible.

A: This is a difficult situation, and you are definitely a good friend for wanting to help your peers. One of the best ways you can help your friends is to let them know you disagree with what they are doing ? sometimes just having that conversation with them is enough to encourage them to change their behavior. Often, teaming up with another friend to talk to your peers can be encouraging and help you get your message across. If this doesn't help, it may be a good idea to talk to a trusted adult about the resources available in your school, or in your community.

A: It's tough to stay away from drugs once a person gets started, but it can be done. It is easier to lead a healthy life away fromdrugs and alcohol with support. The fact that you're setting a boundary with your boyfriend is very good, but you may also want to encourage him to find other resources to help him stay clean. Seeing a trained professional can be helpful and will allow him to develop coping skills to deal with his cravings to use. That professional can also work with him to help him identify potential triggers that cause him to want to use, and how to avoid those triggers or lessen their pull on him.

It may be a good idea for your boyfriend to consider changing his friends if he wants to stay clean ? if he continues to associate with them frequently, and if they continue to use, the combination would likely lead him to using again.

Finally, you have to know that it's not your responsibility to fix this problem for him. You can't make him stay clean, but you can support his good decisions and healthy lifestyle.

A: The fact that you told him that you're concerned about his drug use is the first step (and often the hardest). You can't force your brother to stop using drugs, just like he can't force you to do anything that you don't want to do. One of the most effective ways to help him is to be consistent with what you say to him. For instance, you might say, "you know, I worry about you when you take drugs. If you ever change your mind and need help, I will always be here to help."

Another piece of advice is to make sure that you don't do anything that will enable him to continue using drugs. For instance, don't give him money, don't cover up for him with your parents and don't protect him from the consequences of his drug use (like doing his homework or his chores).

Finally, if you need more support for yourself, there are groups called Al-Anon (which includes Ala-teen for younger people) or Nar-Anon that are for the family members of drug users ? these support groups can give you a lot of other ideas on how to deal with your brother's drug use.

A: The hardest part about getting help is taking the first step and asking for it; once you take that courageous step, you will find that there is a wealth of information, and people willing to help you. Consider confiding in someone you trust and let them know you need help. It might be easiest to start with a friend, and then ask him/her to help you talk to an adult.

It is important that, at some point, you talk to someone who is trained and who has experience with the problems you're dealing with. Whether you are struggling with drug use, family pressures, body image, or food-related concerns (or any other stress that you're feeling), there are professionals trained to help while also respecting your confidentiality.

There will be people there who can relate to you and what you're going through. Also, you can find help locally by calling NCADI (National Clearinghouse of Alcohol & Drug Information) at 1-800-788-2800 to be referred to a confidential hotline in your area or receive other resources.

A: This is a tough situation for everyone involved, but your wanting to help is important in saving her life. It is very important to diagnose and treat eating disorders as soon as possible. At first, eating disorders are often difficult to detect, and teens usually make excuses or deny having a problem or needing help, just like your friend does. But this is exactly when the problem needs to be addressed.

No matter how patient and supportive you are, your friend may not admit to needing help. This can be very stressful and discouraging for you, especially when your friend doesn't listen. You may want to consider discussing your concerns with a respected school nurse or physician, teacher, coach, or counselor. Then they may be able to talk privately with your friend or involve a parent.

Ultimately, she is the one who must realize her eating habits are harming her health, and she may need professional help in order to do this. Keep in mind, that the earlier eating disorders are addressed, the better the outcome.

A: This is a very difficult situation. There are many facts that you could share with him, most of which can be found on this Web site. Here are a few facts:

• Marijuana is a drug that you can get addicted to.
• More teens are in treatment with a primary diagnosis of marijuana dependence than for all other illicit drugs combined.
• Pot smoke contains some of the same cancer-causing substances as tobacco and is harmful to the lungs.
• Marijuana abuse affects your memory and school performance.

These facts may get him to think twice and are worth letting him know about. But even more important is that you tell him you're concerned about him. Check out the Help section for some ideas and examples of what to say and how to try to reach your friend. Making a careful plan and even practicing what you might say is a good idea. Continue to let him know that you are worried about him, that you like him better when he's not stoned, and that you'd like to be his friend, but not when he's using. Even offer to help him quit. Most importantly, don't give up on him, but also don't support his use. Be clear that you'd like to be friends with him, but that he needs to quit for you to spend time with him. Last, try to remember that there is only so much you can do. Be proud that you are trying to help, but don't take responsibility for changing him.

A: There are many effective treatments for depression that can be used instead of, or with, medication. It would be helpful to talk to the professional who diagnosed you so that you can know the intensity of your depression, and to work with them to make healthy choices for treatment – you may find that your depression is at a point where medicine would be helpful, or that these other methods might be better. At any rate, I highly encourage you to work with a professional counselor, therapist or psychologist to determine the best, and most personal, course of action for your situation. With effective talk therapy, you may also want to try improving your diet – less processed food and fast food; more fruits, veggies and whole grains can help your brain chemistry fight off depression. So can a healthy schedule of regular exercise like running, swimming, biking, weight lifting and sports. You may also want to try particular exercises like yoga or tai chi, which can be helpful for anger management as well. I also recommend learning about deep breathing and meditation for depression and anger. Any one of these, or in some combination, may be the key for you. But again, I would highly recommend that you work with a trained professional to monitor your progress, and to formulate a plan that fits your needs.

A: Depression affects much more than just the mind and brain. A common saying among mental health professionals is that “depression hurts”. Many patients with depression experience body aches and pains throughout the day, without a clear reason. The pain can be so severe and difficult to deal with that people cannot work, sleep or relax. Depression can change how well hormones work in our bodies, affecting some that control how strong our muscles are and how much nutrition we take in. It is very possible, although not entirely proven, that depression could affect growth among young people. The combination of increased stress hormones, poor nutrition and poor sleep could possibly affect one’s final obtainable height. Depression can also affect your immune system, which makes you more likely to suffer from colds and infections.

A: This really seems to be a question about respect – does he respect you enough to know you are serious about not using? If he does, the question should never come up, and you should never have to say “No”. On the other hand, do you respect yourself, and your recovery, enough to let him know you don’t want to use? Do you respect yourself enough to walk away from the relationship if he doesn’t understand and persists in trying to get you to use again? It is very difficult to maintain a relationship where one person is using and one person is trying to stay clean. The differences in beliefs and behavior between the two people are a considerable strain on the relationship. As the differences continue to grow, there really is nothing in common between the two people. However, should both people work towards recovery, not only does it help the relationship, but it certainly helps each individual. I would hope you could be a positive influence on him, before he is a negative influence on you.

A: When sadness and feeling down become so intense that you feel like hurting yourself or 'ending it all', it is a definite sign of depression. Other signs that may be present, but don't have to be for depression, would be a noticeable change in eating habits and/or sleeping habits, withdrawal from friends and family, feelings of worthlessness or guilt, and a lack of enthusiasm or motivation.

The best way to find out for sure is to work with a trusted professional who has experience in helping others with these kinds of problems. Usually a counselor or therapist is your best bet. Even thought there may be days you feel "happier than ever", the fact that you are experiencing those very sad days you described, it would be highly recommended to talk to someone about it. By working with a professional that can help you get on track to have more of those 'good days', and put the bad ones behind you. For information on resources and support near you visit http://www.samhsa.gov/treatment/ or call 1-800-662-HELP.

A: Depression as a clinical disorder can be treated in a variety of different ways. Medications are not always needed or used in effective treatment plans but they can be extremely helpful when used properly. Research studies have shown repeatedly that the best method to treat depression is a combination of medications, individual counseling, and lifestyle changes (like regular exercise, healthy nutritional habits, and learning new ways to cope with stress). Antidepressants can be very helpful to improve sleep, concentration, restore energy, reduce the intensity of negative thoughts, and help people be more present during conversations. Counseling is most helpful to deal with life stress, develop new ways of dealing with the world and for understanding how and when depressive symptoms show up.

Whenever parents or family members disagree about depressive symptoms, it is recommended that family meeting take place between all involved persons and the mental health specialists. This meeting will help to figure out which "symptoms" are from the depression, which ones are side effects of the medications, and which ones are part of a person's personality. Whenever patients feel trapped or caught in between family members, meeting with a therapists is the best way of adding clarity to the situation.

A: Depression, like many other psychiatric disorders, runs in families and can be inherited. Science is beginning to figure out which genes are responsible for passing on the risk that makes a family member vulnerable to developing depression. The other major factor that determines whether or not someone becomes depressed is the environment that one lives in. People who experience high amounts of life stress, such as abuse, violence, financial stress, or troubled relationships all have an increased chance of developing depression.

There are a lot of possible warning signs of depression. The most common symptoms are being sad most of the time, not being able to enjoy things, sleeping poorly, not having an appetite, having difficulty completing daily tasks and not having any energy or motivation. Other signs of depression that people don't always consider include being irritable, not being able to feel any emotions, and/or doing things that are different from your usual personality. The best way to tell if you have a treatable, clinical depression is to see a doctor or a counselor.

A: We all have the occasional bad day, or string of bad days. Fortunately there are a variety of ways to cope with bad days without taking it out on friends or family. Music, exercise, and engaging in constructive hobbies are just a few of the things you can do. I recommend calm, relaxing music with deep breathing or meditation. Engaging in strenuous exercise like running or weight-lifting can also have a calming effect. Finally, hobbies, even video games, as long as they are used in moderation, can be fun and helpful for relaxation and de-stressing.

If these methods don't work, it may be helpful to talk to a guidance counselor at school to discuss other coping strategies.

A: Facebook and MySpace have become very popular in recent years. However, that doesn't mean you must have one. Understanding your reasons for not wanting to be a part of these networks is the key to fighting off peer pressure. If you can put these reasons into words, you can express it to those who are pressuring you. Those friends who respect you will also respect your reason for not being a part of MySpace or Facebook, and will stop peer pressuring you.

A: Although it may seem like everyone is smoking marijuana in your school, they are really not. In fact the majority of teens do not smoke marijuana. In 2007, only 16 percent of teens ages 12-17 reported using marijuana in the past month. There are plenty of kids at your school making the smart choice not to use it. It would be a great opportunity for you to build friendships by seeking these kids out. You will find a lot of people your age who aren't using drugs and are doing well in sports, academics, and other areas of life. Spending time with these kinds of people, being a part of these groups, and saying "no" and meaning it will keep you strong in your conviction.

A: Many factors can contribute to a person becoming depressed, and alcohol or drug use are two factors that do make depression more likely to occur. Many people have the wrong impression and think that alcohol is a stimulant, but it is actually a powerful depressant. Depressed people often use alcohol to try to feel better or fit in socially, but this "self-medication" results in the opposite effect ? greater depression. What is known about marijuana is that use, particularly frequent use, causes memory and learning problems, distorted perception, difficulty thinking and solving problems, and a loss of motivation. Chronic pot smoking has been associated with depression, anxiety, and personality changes.

You should feel very good about having made the important choice to stop smoking pot and drinking. Now you can think more clearly about the potential causes of your mood swings and depression, and what to do about them. The teenage years are one of the prime times when depression is common, particularly for girls. Although feeling sad or "blue" can happen fairly often to teens, it is important to recognize when depressive moods are increasing and starting to interfere with daily life, relationships, and responsibilities. It is important that you have a support system, usually with your friends and family, to help you continue to avoid drug and alcohol use, but also to help you decide if you need to seek professional help to get through this low point in your life.