Policy Implications of Multiple Drug Use

Public policies that deal with the use and abuse of alcohol and drugs are very fragmented, reflecting in many ways the history of various substances as well as the role played by the substances in this society. Alcohol is a good example. Because the impact of alcohol on traffic fatalities is so painfully obvious, public interest in the control of alcohol has increased in the recent past. There have been a number of initiatives at Federal, state, and local levels concerning enforcement of minimum age drinking and dram shop liability laws and a push in some areas for raising the driving age. However, very little public policy attention has been directed toward the other control strategies that might have a larger impact on alcohol consumption and its relationship to traffic accidents and fatalities (i.e., changes in laws that would eliminate tax deductions for advertising, restriction of advertising of various types of alcoholic beverages, or substantial increases in the tax placed on alcoholic beverages and thus on the price). After all, when the economics of alcohol is examined it is easy to see how thoroughly interwoven alcohol is in society. The value of alcohol in the advertising, trucking, and agricultural sectors Read more […]

Consequences of Multiple Drug Use: Specifying the Causes

In order to illustrate these points, three specific consequences of drug use will be discussed in some detail below. These three consequences are traffic accidents, involvement in delinquent/criminal acts by youth and young adults, and emergency room visits related to drug abuse. Traffic Accidents The Monitoring-the-Future surveys contain several questions concerning traffic accidents. The seniors are first asked how many accidents (i.e., a collision involving property damage or personal injury — not bumps or scratches in parking lots) they had while they were driving in the past 12 months. If the answer is one or more, the senior is asked how many occurred after he/she was drinking alcoholic beverages and then how many occurred after he/she was smoking marijuana or hashish. By piecing together the information from these separate questions, it is possible to estimate the proportion that would be due to alcohol, to marijuana, and to alcohol and marijuana. The data in Table “Motor Vehicle Accidents and Their Connection to Use of Alcohol, Use of Marijuana, and Use of Both Alcohol and Marijuana” are for seniors in the class of 1980 classified according to the extent of alcohol and marijuana use reported during the Read more […]

The Epidemiology of Multiple Drug Use

How much multiple drug use is there? What proportion of the population at any one point in time is using/abusing multiple substances? Has use of multiple substances become more normative in the recent past as opposed to exclusive use of a favorite drug? What are the principal consequences of multiple drug use? Do these consequences differ according to pharmacological parameters for interactive potential or are there other parameters of almost equal predictive value? To what extent are the consequences attributed to single drugs (traffic accidents labeled as alcohol related) really the result of impaired judgment and performance from ingestion of multiple substances? These are just a few of the questions that need to be addressed within the scientific and public policy communities. In the following section some epidemiological data pertinent to understanding the “extent” of multiple drug use are presented. Monitoring-the-Future Studies Each year since 1975, researchers at the Institute for Social Research at the University of Michigan have administered questionnaires to about 17,000 high school seniors attending schools randomly chosen to be representative of all high schools in the continental United States. These Read more […]

Measuring the Developmental Nature of Multiple Drug Use

There have been a number of studies in which attempts have been made to measure or assess multiple drug use. Some of these are from general populations while others are focused on specific subpopulations of users. The studies are grouped more on the basis of the approach taken to assessing multiple drug use than on the patterns uncovered. There are at least four different groupings of studies and some studies fit into more than one grouping. Developmental Patterns of Onset of Use One of the most influential attempts to describe patterns of multiple drug use is the “stages of drug use” model developed by Kandel. Kandel posited that persons proceed from licit to illicit drugs and from use of less to more serious drugs. The stages of drug use involvement that she identified were: (1) no use of any drugs; (2) use of beer or wine; (3) use of cigarettes and/or hard liquor; (4) use of marijuana; and (5) use of illicit drugs other than marijuana. Although it is not made explicit by Kandel, there is an implication that the drugs from the earlier stages of development are “carried forward” into the later stages of drug involvement. Thus, a marijuana user is likely to continue his or her use of cigarettes/hard liquor and beer Read more […]

Cocaine Abuse: A Review of Current and Experimental Treatments

Cocaine abuse is a recently revived drug problem that is again generating great popular concern. Unfortunately, scientific evaluation of cocaine abuse treatment has been surprisingly sparse kind no consensus exists regarding optimal treatment strategies. This review summarizes current treatment issues and regimens. as well as preliminary data on new, approaches to cocaine abuse treatment. Since this chapter will deal with treatment of the cocaine abuser, it is important from the outset to define what is meant by that term. Although in some settings any use of illegal drugs equals abuse such a definition is more legal than medical and will not he used here. Instead the definition of drug abuse found elsewhere in the field will be employed namely…“the nonprescription use of psychoactive chemicals by an individual to alter his her psychological state in a situation in which the individual or society incurs some harm” (). The great majority of cocaine users applying for treatment fit into this definition. The most common exception is the individual who defines his use as recreational controlled and nonharmful but is brought to treatment by another (e.g. spouse, parent), while the significant other views the cocaine Read more […]

Cocaine abuse treatment strategies

Strategies devised to treat cocaine abuse have existed since its intractable lure for some first became obvious almost a century ago. During this period no generally accepted or successful treatment has emerged. Chronic cocaine abuse has been assumed to cause no physiologic withdrawal state on discontinuation because of insufficient evidence for an abstinence syndrome of major physiological changes like the classic sort characterizing sedative or opiate withdrawal (). Cocaine abuse has thus been assumed to be a “psychological dependence” rather than one involving neurophysiological adaptations, and currently used treatments consist of psychological strategies aimed at modifying addictive behaviors. Issues related to current psychological strategies will be discussed first, followed by a summary of evidence indicating cocaine abuse may cause neuroadaptation. The latter includes a review of pharmacological strategies, aimed at reversal of such adaptation, which may hold future potential as adjuncts in cocaine abuse treatment. Cocaine abuse treatment strategies: Current treatments Potential New Directions in Treatment Despite the past assumption that cocaine abuse is a “psychological addiction,” it is plausible Read more […]

Cocaine abuse treatment strategies: Current treatments

Only two comprehensive efforts at cocaine abuse treatment are described in the modern literature. Both are nonpharmacological, but each involves a very different approach to treatment. Anker and Crowley () have adapted the behavioral method of contingency contracting () for cocaine abuse. The contract involves such contingencies as the therapist’s holding letters of notification of cocaine abuse or resignation of professional licenses, written by the patient with content chosen specifically because of severe irrevocable personal effects, and mailing them to drug enforcement authorities, employers, or licensing boards upon finding evidence of cocaine use in urinalysis or after missed urinalysis. Such treatment appears to effectively induce abstinence in those willing to take part. Anker and Crowley report 48% of their sample were willing to engage in this treatment, with over 90% cocaine abstinence during the duration of the “contract.” Over half of these patients relapsed following completion of the “contract” (), however, even though the sample was a presumably well motivated and well educated group. The patients declining “contracts” (52%) were treated with supportive psychotherapy which was also used as Read more […]

Internal Stimulus Control and Subjective Effects of Drugs

For many years psychotropic drugs have been characterized and classified using methods designed to measure their subjective effects in humans (). This research approach has two principal purposes: 1) to investigate the efficacy of a drug in attenuating unwanted subjective states in patients (e.g., pain, anxiety, depression), 2) to investigate the abuse potential of new drugs by comparing their subjective effects in experienced drug abusers to those produced by known drugs of abuse. In regard to the latter, such methods have been used to determine whether there are any common subjective states produced by all drugs of abuse (e.g., euphoria). Systematic studies of subjective methods for drug classification have been conducted at the Addiction Research Center (ARC) in Lexington, Kentucky, now part of the National Institute on Drug Abuse. A major mission of the ARC has been to evaluate new analgesic compounds to determine whether they produced morphine-like effects. The subjective effects of morphine and related compounds were an important aspect of this evaluation. The research demonstrated that morphine and related narcotic analgesics produced a unique spectrum of subjective effects that can be reliably discriminated Read more […]

History of Drug Exposure as a Determinant of Drug Self-Administration

The purpose of this paper is to review how a drug’s effectiveness in initiating and maintaining self-administration can be influenced by a subject’s past experience with drugs. Drug self-administration by humans and laboratory animals is considered an instance of operant behavior (), controlled by the subject’s genetic constitution, past history, and the current circumstances of drug availability (of Skinner, 1938). The influence of history of drug exposure on current drug-maintained behavior may be controlled, in turn, by the particular drugs and doses employed and the conditions under which the drug is administered. This discussion will focus on the ways in which a history of drug exposure can control later drug self-administration in laboratory animals. Effects of history of drug exposure on initiation of drug self-administration In order to study drug self-administration by laboratory animals, an experimenter must set up a situation in which subjects are exposed to some contingency between the occurrence of a specific response and delivery of a particular drug. For many drugs, no explicit behavioral or pharmacologioal history is necessary for the drug to maintain behavior. In one initial study, for example, Read more […]

The global regulation of opiates: the role played by the United States

In the late 20th century there is a global system in place regulating all trade in opiates. It is worth investigating why the regulatory regimes did not remain national in scope, such as, for instance, the formal aspects of alcohol control. What are the roots of the current global regulatory regime for opiates? The national protest movements in Britain and the Netherlands that have been described above, whatever part they may have played in shaping public opinion, were certainly not decisive in bringing about the decline and eventual abolition of the colonial opium trade. The crucial factor was the international political climate, which, around the turn of the century, turned resolutely against this particular brand of commercialism. The international furore about the opium trade that arose at this time was part and parcel of a general process of decolonization in the region that would unfold completely later in the 20th century, a process that would be directed by the United States, that well knew what it meant to be a colony. As an incipient world power, the US took the lead in suppressing the international trade in opium, which conflicted with the interests of colonial powers past their prime such as Britain Read more […]