DAILY DOSE

I drink, smoke dope, pop Vicodin and take Prozac.

Why hasn't my body given out yet?

Dear Buzzed,

I have been playing with various substances since I smoked my first joint
in Aspen, Colo., in 1981. I have smoked (more or less) every day since and
have suffered none of the cliched pitfalls (yet). I've received a B.A.,
have fathered two children and have an income of $54,000 and a mortgage.

I also have been a heavy drinker since my Memphis State days and continue
to indulge -- whenever the demands of work and parenting will allow,
usually later at night. Add in the fact that I have recently discovered a
means of obtaining painkillers (Vicodin) via the Internet and I'm feeling a
little like a junkie, which -- let's not be coy -- I am.

I've also been taking Prozac (20 mg) for the past six months to try to
combat my obsessive-compulsive behavior. (I told my doctor that I wanted to
try Prozac to help me stop smoking -- which is partially true, just not
tobacco.) Anyway, that seems to have no effect lately, but I'm constantly
surprised by how my physical stamina has held up against my barrage of abuse.

I've had annual physicals with complete blood work, and my reports all come
back fine. My liver numbers are fine, my blood pressure is fine, and
although my cholesterol is rather high, my doctor seems almost annoyed at
my insistence on having these checks. My question is, are there some people
whose systems can take it better or for longer than others? It seems to me
that I should have been dead years ago. So many others have died from their
overindulgences (Keith Whitley, Alexander Gudonov, various rock stars, etc.).

So why am I still around? I can't keep this up forever. I know this
question seems stupid, but I am totally serious: When am I going to give out?

Concerned Junkie

Dear Junkie,

You wonder why you are doing fine despite regular heavy drinking, daily
smoking (we assume you mean pot) and occasional Vicodin (generic name:
hydrocodone). So do we! You've given us a lot to talk about -- regular and
heavy alcohol use, drug combinations, use of addictive narcotics and
resistance to antidepressants. Where to begin?

First, you are doing a couple of things right. Limiting your drug use in
response to the demands of parenting and work means that you have the
ability to keep it under control. You are also having regular physicals and
working with a doctor -- at least to some degree, if not fully honestly --
on your substance abuse problem. This is all good. Now, on to your various
indulgences.

You didn't tell us how much you are drinking. If you are drinking no more
than a couple of drinks every day, you probably won't experience
significant negative health consequences, and you may even derive some
cardiovascular benefit. On the other hand, if you are drinking more than
that, you might be surprised to know that heavy alcohol use can be the most
dangerous part of your daily routine. As you guessed, your liver and
cardiovascular system suffer the most from alcohol use. And alcohol could
be playing a part in your elevated cholesterol levels.

One joint a day of marijuana is unlikely to cause serious physical problems
in the short term, and the long-term risk of lung and cardiovascular
disease is less than from smoking one pack of cigarettes. However, the
marijuana will impair your memory and could well impair your job
performance. Its sedative properties and anxiety-reducing effects may leave
you unmotivated to do much of anything.

Even the Vicodin, if you keep it under control and don't become addicted,
won't have terrible physical consequences, although it could put a crimp in
your sex life and make you constipated. It is a fairly mild narcotic, and
many people take it as a prescribed medication for years without suffering
any ill effects.

Our greatest worry is about your combined use of all these psychoactive
drugs. You certainly can't be as sharp mentally as you would be without the
drugs. If you smoke pot every day, it is basically always in your system,
since it takes your body up to a week to clear 90 percent of even one dose
of the active ingredient, tetrahydrocannabinol (THC). Adding this to the
alcohol and Vicodin means that you are overloading yourself with too many
depressant drugs. Furthermore, the more drugs you take, the greater the
chances of experiencing a dangerous interaction with prescribed drugs
should you get sick or have an accident.

Also, things must not be going so well for you emotionally if you are
taking antidepressants. Frequently, heavy alcohol drinkers also suffer from
depression, and it is not clear if that results from their drinking or if
they are drinking to cope with an underlying depression. The only way to
really figure it out is to stop drinking.

You are obviously worried enough to go to a doctor for Prozac. You might
have picked a good strategy for dealing with your substance abuse. Prozac
might have some ability to decrease the addictiveness of several drugs,
including alcohol and narcotics. And you correctly observe that the
effectiveness of antidepressants can wane. This antidepressant resistance
is just your brain adapting to the chronic presence of the drug. Talk to
your doctor, who might suggest increasing the dose or switching to another
antidepressant.

As for why you are physically OK so far -- well, you haven't set the bar
very high when you compare yourself to the entertainers you listed. On the
rock star scale of overindulgence, you are an amateur. Nevertheless, you
are engaged in a pattern of drug use that could lead to serious problems,
and we are glad you are concerned.

About the writer Cynthia Kuhn, Ph.D., is a professor of pharmacology at
Duke University Medical School and heads the Pharmacological Sciences
Training Program at Duke. She is coauthor of "Buzzed: The Straight Facts
About the Most Used and Abused Drugs From Alcohol to Ecstasy" and of
"Pumped: Straight Facts for Athletes About Drugs, Supplements and Training."

Wilkie Wilson, Ph.D., is a professor of pharmacology at Duke University
Medical School. He studies how drugs affect the brain, particularly the
processes of learning and memory. He is also coauthor, with Cynthia Kuhn,
of "Buzzed" and "Pumped."