Author(s): Moreira, Diana ; Pereira, Celina ; Cruz, Marta ; Dias, Paulo C. ; Leite, Ângela
Date: 2025
Persistent ID: http://hdl.handle.net/10400.14/54854
Origin: Veritati - Repositório Institucional da Universidade Católica Portuguesa
Subject(s): Addiction; Neurological disorders; Psychoactive drugs; Spinal cord injuries; Substance abuse
Introduction: Substance use disorders (SUDs) are chronic brain conditions with significant neurological consequences, yet the specific neurological effects of psychoactive substances remain insufficiently characterized. This systematic review investigates the neurological sequelae and comorbidities associated with psychoactive substance abuse. Methods: Following PRISMA guidelines, we addressed the question: What are the neurological effects and comorbidities of psychoactive substance use in addiction? A search of EBSCO, Web of Science, and PubMed identified 330 articles (1967–2023), with 13 studies meeting inclusion criteria after rigorous screening. Results: Stimulants, opioids, cannabis, and hallucinogens were linked to stroke, with risk modulated by substance purity, administration routes (e.g., intravenous use), and polysubstance combinations. Opioids contributed to ischemic strokes via cardiac arrhythmias and haemorrhagic strokes through vasculitis or hypertension. Current substance users exhibited a 13.8% stroke incidence and higher mortality. Spinal cord injuries (SCIs) were associated with pre-injury opioid, alcohol, and cannabis use, worsening post-injury complications such as infections and poor rehabilitation outcomes. Demographically, younger individuals with SCI reported higher cocaine and hallucinogen use, while older adults showed greater tobacco and alcohol dependence. Conclusions: Psychoactive substance use elevates risks of stroke and SCI through neurotoxic, vascular, and behavioral mechanisms. These findings emphasize the urgent need for integrated clinical models that address addiction and neurological comorbidities simultaneously. Multidisciplinary approaches, combining neurology and addiction care, are critical to mitigating long-term disability. Future research should prioritize longitudinal studies to unravel chronic neurodegenerative outcomes and refine harm-reduction strategies. This work advocates for policy reforms to expand access to evidence-based SUD treatments, particularly in underserved populations.
