Attentive

Dear Attentive,

You are asking about a subject that evokes almost as much controversy as any health issue we've seen lately. ADD, also known as ADHD (attention-deficit hyperactivity disorder), is a hot topic these days because many kids, and a notable number of adults, are using stimulants like Adderal (an amphetamine) and Ritalin (methylphenidate) to help them focus on a task, whether it be schoolwork or sophisticated engineering analyses. To illustrate just how widespread the use of stimulants can be, we heard about a school system near us in which 12 percent of the children were being given stimulants for attention problems.

Stimulants work, and they can make a huge difference in some people's performance. What we don't know is exactly how they work and who really needs them. So with that caveat in mind we'll engage in a little informed speculating for you.

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After an accident, I spent several months in physical therapy and on painkillers. I have fully recovered, but I'm having a very, very hard time ending my use of painkillers. I have resorted to ordering them over the Internet, and even purchasing them from another accident victim. Each time I try to quit cold turkey I get as sick as a dog and relapse, while tapering off leads to even more use. What can I do?

Addicted to Painkillers

Dear Addicted,

You have experienced both the good and the bad sides of narcotic analgesics, since that is almost certainly what your doctor gave you after your accident. We are really glad that you wrote, because you represent a large group of people who feel embarrassed about their use of narcotics. You shouldn't be. These are good drugs when taken properly.

Morphine and codeine are the "natural" members of this group because they come from the opium poppy. Meperidine, methadone and oxycodone are the synthetic members, and heroin is the most infamous, known more for its addictiveness than its ability to kill pain. Because these medications are the most effective analgesic (painkilling) drugs that exist, doctors frequently prescribe them after surgery or serious injury.

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Wondering

Dear Wondering,

It sounds to us like you got much more than you bargained for. As you probably know, lots of people combine the use of marijuana and alcohol, and we certainly don't hear reports of such powerful effects. (However, if we've missed something, we hope our readers will tell us!) We think you were right to suspect that you were given an additional drug -- more about that shortly.

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Broken Out

Dear Broken Out,

First of all, we are happy that you are being conscientious about taking your lithium. Lithium can dampen the mood swings people with manic-depressive illness experience -- the feeling of one moment being euphoric, the next in deep depression. However, you have to take lithium every day to experience this mood-stabilizing effect. Unfortunately, lithium has many side effects, including nausea, sleepiness, excessive urination, weight gain, changes in the thyroid gland, and -- you guessed it -- bad acne. Some people stop taking the drug for these reasons alone. But quitting lithium can be life threatening. A manic or depressive incident can often follow, so it's important to speak with a physician before altering your regimen.

Lithium works because it affects crucial chemicals in your brain. It has so many side effects because it also affects similar enzymes in the rest of your body. This medication can make it harder for your kidney to concentrate your urine, so many end up having to run to the bathroom all the time. Similarly, lithium probably affects skin chemicals in the same way, and this makes your face break out.

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Curious

Dear Curious,

You've asked about a group of plants -- jimson weed (thorn apple), mandrake, henbane and deadly nightshade -- that have fascinated humans for at least 3,500 years. The ancient Egyptians and Greeks wrote about their various uses as poisons, medicines and hallucinogens. They were also popular with magicians and healers through the Middle Ages and with Native American tribes of North America. The active chemicals have been refined into modern medicines that are used to treat asthma and motion sickness, though some people still smoke or drink plant extracts for their intense hallucinatory properties.

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Stimulated

Dear Stimulated,

You're asking a great question, because the world is being flooded with all sorts of dietary aids and supplements, including ephedrine. And unfortunately, there's a dearth of reliable information about these products.

What we know about ephedrine is this: It is a powerful stimulant of the sympathetic nervous system -- it gets you ready for "fight or flight." Like all stimulants, it increases your heart rate and blood pressure to better supply the body with nutrients and oxygen. It also raises the amount of glucose in the blood, and dilates the bronchioles of the lungs to allow you to breathe better -- just what you need to go into battle or run like hell. (It has been used to treat asthma in Asia for thousands of years.)

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In Search of a Natural High

Dear Natural,

When you ask about recreational mushrooms, we assume that you mean one of the several genera of mushrooms -- Psilocybe, Conocybe, Panaeolus and Stropharia -- that contain the hallucinogenic compounds psilocin and psilocybin. Typically, these appear as dried mushroom caps that the user either eats or makes into a tea.

Most of these mushrooms are not terribly dangerous to you physically. Over the past 34 years, there has been only one report in the medical literature of a death associated with use of these mushrooms. In this case, an 18-year-old experienced a disturbed heart rhythm. Although adverse effects like this can happen, it is far more likely that a person will vomit and experience mild cardiovascular system stimulation after ingesting these mushrooms.

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Good Mother Who Needs to Get Stoned

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In Recovery

Dear In Recovery,

Congratulations on maintaining your recovery from alcohol addiction for all this time. We can understand that you would worry about damage you might have done to your brain and other parts of your body. Many people in recovery from different addictions have the same concerns. In your case, we don't think you have much to worry about. We've looked at the research literature and talked to physicians who treat people in recovery. If you survive serious alcohol dependence and stay in recovery, the data shows that your health will be fairly good.

Alcohol is one of the most well-researched recreational drugs, and we know a lot about the acute effects of this drug. Most people know that it has toxic effects on almost every major organ system at high levels, and in low doses (about one to seven drinks per week) it probably promotes cardiovascular health. However, most people are not aware that the safe limit for women is just one drink per day and for men it is two drinks per day. Beyond that, alcohol promotes liver disease, heart disease, hypertension and cancer. At higher levels (about three drinks per day), there's a chance of injuring the brain and, as psychologists say, producing cognitive deficits.

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Loving My Menthol

Dear Menthol Lover,

While we can't set your mind at ease about smoking cigarettes, we can at least reassure you that the menthol in menthol cigarettes is not crystallizing in your lungs or otherwise damaging your health. There are hundreds, and perhaps thousands, of health-damaging molecules in cigarette smoke -- from carbon monoxide to nicotine to formaldehyde to polycyclic hydrocarbons -- that cause cancer. However, you probably don't need to worry too much about the menthol.

Menthol is a molecule that is purified from plants of the mint family, either peppermint (Mentha piperita) or cornmint (Mentha arvensis). It has been used in products including toothpaste, cold remedies and peppermint candies for at least 100 years.

Menthol makes skin feel colder by stimulating the nerve endings that detect cold. This same cooling feeling gives the sensation of nasal decongestion, and cools the taste of burning cigarettes. Providing this feeling and a nice aroma is about all that menthol does. Although menthol is widely used in cough and cold preparations, it doesn't do too much besides make the air smell and feel nice.

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Aspiring Artiste

Dear Aspiring,

You've asked Buzzed a tough question because there is not much research about drugs and creativity. Creativity is a subjective part of the human experience, and to answer your question, someone would have to give people drugs and then measure their inspiration -- not an easy task for two reasons. First, since the government believes that most of these drugs have no medical benefit, there are legal barriers to doing such research in humans. Second, our usual animal subjects, rats, don't tend to express much observable creativity, so we can't use them either. We can only talk about a small amount of human research done before the drugs became illegal. Unfortunately, most of that research was done without controls and by people who were strong advocates of drug use. As a result, we really don't have much high-quality data.

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I like to use amyl nitrite; I use it almost every time I have an orgasm. I find that I alternate between the actual amyl and the products available online such as pc1 and Rush. What are the health implications of taking a few sniffs of this on a daily basis? Is it carcinogenic? Am I damaging my liver? Can it cause rosacea? I'm aware that it can be fatal if used with Viagra, but there does not seem to be any other information on long-term use. I can't seem to find this information in any other place on the Web. Thanks for a great service!

Rushing my health

Dear Rushing,

There's an old expression known to every pharmacologist: "Every drug has at least two effects, the one you know about and the one you don't." In this case, we know a lot about how amyl nitrite -- sometimes called poppers -- affects the cardiovascular system, and practically nothing about how it affects the brain, especially orgasms.

Speaking of explosive moments, amyl and other nitrites used for sexual enhancement are very close cousins of nitroglycerine, the same chemical used in explosives. It is also used to reduce heart pain (angina) caused by clogged arteries. All of these chemicals work as heart medicine because they relax the smooth muscle tissue in the walls of the arteries. When these muscles relax, the arteries expand and more blood flows through the clogged area.

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Afraid of Getting Caught

Dear Afraid,

We congratulate your girlfriend on her new job, but she may have a problem. Unfortunately, pot sticks around in the body longer than any other recreational drug. It could be detectable for anywhere from five days to several weeks after that amount of use, and there is nothing your girlfriend can do to guarantee a clean drug test. For just one joint, it takes the body up to eight days to rid itself of marijuana's chemicals -- both the active ingredient (tetrahydrocannabinol, or THC) and its metabolites. Since your girlfriend is smoking a joint every other day, most likely there is always some THC in her system.

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Lysergically Nostalgic Mom

Dear Nostalgic Mom,

Although we have no evidence about the role of the CIA, we do know that lots of bad research has been done about the risks of LSD, and publicity of these results has created skeptics like you. We are delighted to discuss the real and dispel the imagined dangers of LSD.

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Hooked

Dear Hooked,

As GHB (gamma hydroxybutyrate) has become more popular, lots of people who began using it for a little fun or (mistakenly) for bodybuilding found that they could not stop without substantial withdrawal problems.

GHB is unique among recreational drugs. People think it is perfectly safe because it is naturally present in the brain and is part of the signaling system between nerve cells that regulate processes ranging from breathing to learning. Normally, the brain exquisitely controls the location and amount of GHB, but when you take it as a drug, all of this order is upset. It makes you euphoric and uninhibited, kind of like alcohol -- that's why people like it. It is also a sedative and is used in Europe as an anesthetic. As it disinhibits and sedates you, it also produces amnesia, and because of that it has unfortunately become a common "date rape" drug.

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Super Coffee Man

Dear Super Coffee Man,

Caffeine is the psychoactive ingredient in coffee, tea, cola and "guarana," as well as in No-Doz and other over-the-counter "stay awake" pills. Caffeine is a mild stimulant: It wakes you up, stimulates your cardiovascular system a little and perhaps helps mobilize your energy resources. It even helps pain relievers suppress pain. And, of course, it's a "diuretic," which explains the common morning bathroom break after the coffee break.

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Hung Over

Dear Hung Over,

Buzzed is very, very sympathetic. If we really had the cure for hangovers, we'd be more than buzzed -- we'd be rich and, on occasion, we'd feel a bit better ourselves.

Hangovers are believed to occur as a result of three different processes. Everyone knows you sweat and urinate a lot when you drink, possibly leading to dehydration. Your brain also quickly adapts to the presence of the ethanol, and when you stop drinking, parts of your brain and heart become excitable (giving you that jittery feeling). Add to that the metabolism of ethanol -- which produces a chemical called acetaldehyde -- and you've arrived to that hellish, miserable state we refer to as being hung over.

While Tylenol (acetaminophen) is normally a very safe drug -- hospitals use it all the time because it doesn't have the problems of most other painkillers -- if you take it when you're drunk, the alcohol interferes with the acetaminophen's metabolism, and you risk damaging your liver.

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Today marks the debut of our weekly column. We're both professors of pharmacology at Duke University Medical Center and have spent years studying the effects of drugs on the brain. We're also coauthors of the book "Buzzed: The Straight Facts About the Most Used and Abused Drugs From Alcohol to Ecstasy" and of the forthcoming "Pumped: Straight Facts for Athletes About Drugs, Supplements and Training." We're ready to tell you anything you want to know -- from the pros and cons of taking a certain prescription medication to the biological effects of date rape drugs.

So go ahead, ask us anything. Send questions to buzzed@salon.com. And look for the answers every Wednesday in this space.

Dear Buzzed,

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