Meanwhile, researchers continued to investigate the new drug’s potential as a topical anesthetic. Doctors performing delicate operations on eyes discovered that cocaine numbed tissues, allowing them to perform surgery with only minor discomfort to the conscious patient, who could continue to move the eye as directed. The use of cocaine soon spread to surgery of other body parts, including the ears, nose, and mouth. Not only did cocaine numb the targeted area, but the patient remained awake. This allowed the doctors to converse with their patients during surgery, which helped the doctors to monitor their progress. Several pharmaceutical companies noted the success of cocaine as an anesthetic and during the 1880s began selling large amounts of the drug to hospitals. Other physicians saw cocaine as possibly benefiting mental patients. In 1884, for example, the Austrian psychiatrist Sigmund Freud performed his own study of cocaine. Based on that study, Freud published a paper, Tiber Coca, in which he recommended the use of cocaine to treat a variety of conditions, including depression, morphine addiction, digestive disorders, and asthma. Freud tried taking cocaine himself and noted cocaine’s effects as a mental stimulant Read more [...]

The debate over whether or not cocaine is addictive is ongoing and complicated. The majority of mental health professionals take the view that regular cocaine users cannot voluntarily stop taking the drug. In this sense, cocaine meets the definition of an addictive drug. Moreover, these experts believe that cocaine use leads to physical changes in the brain that encourage continued use. Journalist Norbert R. Myslinski reports: According to Prof. Karen Bolla of Johns Hopkins University, cocaine impairs memory, manual dexterity, and decision making for at least a month. Her study suggests damage to the brain’s prefrontal cortex, leading to loss of control over consumption of the drug. A deadly spiral is set up, making it more and more difficult for the addict to quit. Continued drug abuse becomes increasingly a matter of brain damage and less a matter of weak character. Another study performed by researchers at Rockefeller University in New York City confirms Bolla’s conclusions and provides a detailed explanation of the brain chemistry of a chronic cocaine user. The Rockefeller University investigators found that repeated exposure to cocaine causes a change at the molecular level that alters a brain protein called Read more [...]

Although the majority of Americans favor the illegal status of cocaine and crack, not everyone shares this view. One of the most prominent advocates of legalization of cocaine and crack is Nobel Prize-winning economist Milton Friedman. In 1991, libertarian psychiatrist Thomas Szasz, a vocal opponent of drug control, interviewed Friedman for a radio broadcast called “America’s Drug Forum,” a transcript of which is available at the Schaffer Library of Drug Policy website. Szasz begins by asking Friedman how America would change with the legalization of drugs. Friedman: I see America with half the number of prisons, half the number of prisoners, ten thousand fewer homicides a year, inner cities in which there’s a chance for these poor people to live without being afraid for their lives, citizens who might be respectable who are now addicts not being subject to becoming criminals in order to get their drug, being able to get drugs for which they’re sure of the quality. Szasz: Let us consider another drug then, and that is the drug crack. Friedman: Crack would never have existed, in my opinion, if you had not had drug prohibition. Why was crack created? The preferred method of taking cocaine, which I understand Read more [...]

Alcohol is one of the oldest drugs known and it affects virtually every organ system in the body. The number of physiological systems affected by alcohol is staggering both in the scope of medical consequences and in terms of the economics of medical treatment of alcohol-related disorders. Alcohol damages the heart and can elevate blood pressure. It can increase the risk for heart failure and stroke. Excessive alcohol consumption can injure various tissues, produce diverse physiological changes, and impair and interfere with the hormonal and biochemical regulation of a variety of cellular and metabolic functions. Chronic alcohol exposure increases the risk for certain forms of cancer, and both acute and chronic alcohol use significantly increases the risk for accidental injuries and impairs the recovery from those injuries. However, not all of the medical consequences of alcohol use are deleterious. Substantial research indicates beneficial effects of this drug. Nonetheless, the economic and psychosocial costs of alcohol use in American society alone are estimated at more than $200 billion per year. This chapter will review the most significant and well-known medical consequences of alcohol use and abuse in four basic Read more [...]

Accidental injuries are a direct medical consequence of alcohol intoxication and it is well known that alcohol increases the risk for injuries through impairment of cognitive and psychomotor functioning while performing or engaging in a variety of behavioral activities. Among these, the effects of alcohol on automobile, bicycling, motorcycle, boating, aquatic and pedestrian injuries, as well as homicide, suicide, and death from fire have been examined. Impaired Driving Pedestrian and Fall-Down Injuries Although the relationship between alcohol intoxication and automobile accidents is by far the most well studied of alcohol-caused injuries, investigation of the role of alcohol intoxication in other types of injuries is growing. For example, pedestrian-like behaviors are also impaired by alcohol. Since driving and pedestrian activity rely on divided attention and visual-motor processes, it is reasonable to infer that they share similar alcohol-induced changes in relative risk. Injuries related to falls are the second leading cause of accidents in the United States, and account for about 13,000 deaths per year. Most studies suggest that alcohol increases the risk for injuries due to falls, but one study in particular Read more [...]

Driving while intoxicated is probably the most well-studied injurious consequence of drinking. Whereas the older scientific literature on drinking and driving focused on the effects of high blood alcohol levels on simple reaction time, on the visual system, and on gross impairment, it is now known that the effects of alcohol are much broader and occur at relatively low blood alcohol levels. For example, alcohol use is coupled with increased risk taking and impulsivity, at least among young males, and decreased seat belt use which invariably places drinkers at increased risk for injury. Moreover, whereas high blood alcohol levels (>.15 percent) may produce obvious visible impairment in the absence of any testing, it is now known that very low levels of alcohol (.02 to .03 percent) impair the performance of complex divided attention tasks, at least in laboratory studies. Divided attention is believed to be a critical factor in a variety of tasks outside the laboratory, and divided attention failure is the most likely cause of motor vehicle collisions at blood alcohol levels above .05 percent, for it is at this level that impairment translates into actual highway statistics (in which the intoxicated driver is the cause Read more [...]

Not only does alcohol intoxication produce direct medical consequences as a result of injuries (e.g., fractures, traumatic amputations, etc.) sustained in a motor vehicle crash, for example, it may also affect injury outcome, particularly head injuries. This is highly significant since up to half of traumatic brain-injured patients have blood alcohol concentrations of .10 percent or more at the time of injury. For example, motorcycle riders with head injuries are about twice as likely to have fatal head injuries if they are intoxicated than similarly injured riders who are sober, and contrary to popular misconception, drunk drivers are more likely to be seriously or fatally injured than sober drivers. Alcohol-intoxicated accident victims with central nervous system injuries were more than twice as likely to die sooner than anatomically matched controls. The mechanisms of the exacerbating effects of alcohol on central nervous system injuries are intriguing, but not well understood. Animal studies suggest that the mechanism may be due to the inhibition of free radical scavengers such as dimethyl sulfoxide, alcohol-induced cerebral edema as a result of lipid peroxidation, or increases in plasma osmolality. However, Read more [...]

Although it is not difficult to appreciate the positive and causal relationship between alcohol intoxication and skeletal fractures — one need only look at the large number of motor vehicle and slip-and-fall injuries involving alcohol intoxication — this relationship is more complex and certainly did not start with current epidemiological studies. In fact, the relationship between alcohol abuse and increased risks for skeletal fractures was observed by the ancient Egyptians. This relationship has since been confirmed by research that suggests alcoholics suffer from a generalized skeletal fragility and are prone to fracture. Alcohol-Induced Fractures Alcohol-Induced Osteoporosis In addition to the risk of falls and related injuries previously reviewed, some evidence suggests that alcoholics may also suffer from a generalized skeletal fragility. Bone density is a predictor of fractures and the term osteoporosis is synonymous with low bone density or osteopenia (NIAAA). Saville was the first to demonstrate the association of osteopenia with alcohol abuse. Studying the bone mass of cadavers, Saville found marked reductions in the bone mass of persons with a history of alcoholism and further noted that the bone mass Read more [...]

Current scientific research on the prevalence of fractures in alcoholic subjects is based on epidemiological studies. Those results are generally inconsistent, but there is some evidence of a positive association between alcohol intake and fracture occurrence. For example, men hospitalized for alcohol-related problems are four times more likely to have rib fractures than nondrinking patients and up to 14 times more likely to have spinal-crush fractures. In a prospective study, Tuppurainen et al. (1995) found alcohol intake higher among 3,140 perimenopausal women who experienced fractures than among those without fractures. Women who drank alcohol had a risk of a fracture that was about 50 percent higher than among women who did not drink. In another study, increased weekly alcohol intake was associated with greater risks for osteoporotic fractures in postmenopausal women. In the Paganini-Hill study, osteoporotic fractures in women who consumed more than eight drinks per week were almost twice as likely as in nondrinkers. Similarly, a survey of 84,500 U.S. women (ages 34 to 59) who consumed 25 grams of alcohol per day was associated with a 133 percent increase in risk for hip fractures and a 38 percent increase in Read more [...]

The normal growth of bone cells depends upon a variety of orchestrated factors, including adequate nutrition and the function and interaction of various hormones and intercellular regulating factors. Research in this area suggests that while the exact mechanism through which alcohol affects the integrity of the skeleton is not known, much has been learned. Even so, likely candidates have not been clearly identified. Chronic consumption of relatively low amounts of alcohol (one to two drinks per day for women; three to four drinks per day for men) can interfere with the normal metabolism of nutrients. As a result of poor diets, impaired nutrient absorption, or increased renal excretion, alcoholics often have deficiencies in minerals such as calcium, phosphate, and magnesium, as well as low levels of vitamin D, which is necessary for the absorption of calcium from the intestinal system. However, there is little histomorphometric evidence that nutritional deficiencies related to alcohol use are a major cause of alcohol-induced bone disease. Another candidate that may contribute to alcohol-induced bone disease is calcitonin, a peptide produced by the thyroid gland. Calcitonin inhibits bone resorption, in effect protecting Read more [...]