A Review of Drug Abuse Data Bases: the National Survey

The data base which appears to provide the most consistent source of drug use data on youth and young adults is the National Survey co2nducted between 1971 and 1977. There are five studies in this series. The first two surveys were conducted for the National Commission on Marihuana and Drug Abuse. The most recent three were conducted for the National Institute on Drug Abuse. The five studies are entitled: 1) 1971 study: Public Attitudes Toward Marihuana. 2) 1972 study: Drug Experience, Attitudes and Related Behavior Among Adolescents and Adults. 3) 1974 study: Public Experience with Psychoactive Substances. 4) 1976 study: Nonmedical Use of Psychoactive Substances. () 5) 1977 study: National Survey on Drug Abuse. () These surveys share several critical characteristics which contribute to their utility for estimating drug use: Data collection on the “at risk” 18-25 year age bracket; Adequate and consistent sampling methodology; Comparability of drugs investigated; Comparability of question formats; and Accessibility of detailed tabular data. Each of the five studies is discussed below to demonstrate its adequacy as a data base for projecting the number of drug users in the United States Read more […]

Epidemiology and the Course of Narcotics Use

What happens to those who finally succumb to the lure of narcotics? Most such individuals have had at least some prior experience not only with tobacco and alcohol, but also with marihuana and a veritable pharmacopoeia of other substances, ranging from glue and other toxic substances to various opiate-laced drugs, barbiturates, amphetamines, and other somewhat less common depressants, psychedelics, and stimulants (). Only a small subset ever move on to heroin, currently the most common opiate and the one about which there is most societal and policy concern. More individuals are reported to have used nonheroin opiates. Yet, in most communities they abort nonheroin opiate use, or they transform their allegiance to heroin. Although the lure of opium and morphine has been long acknowledged -strengthened by the difficulty that identified compulsive users have had in abandoning their dependence – the myths about heroin are at least as firmly established as those developed in the early struggle concerning opium (). Myths not only exist in the public mind, but are also promoted by addicts and the professionals who work with them. For example, the title of one popular book written by one of the more progressive and enlightened Read more […]

Substance-Related Disorders

The ability to recognize and treat substance use disorders (SUDs) is a core competence in psychosomatic medicine. SUDs are common in both inpatient and outpatient medical settings. Alcohol and tobacco use alone contribute to a host of medical illnesses. Illegal drug use taxes the health care system. Drug and alcohol dependence disorders are best characterized as chronic medical illnesses. Hepatitis C is an example of a potential long-term complication of even brief drug use, injection drug users being at increased risk. Emergency departments have seen a steady increase in overdoses of drugs, including “club drugs” not prevalent until recently. The long-term effects of perinatal drug abuse are becoming known. Devastating complications result from the internal concealment of illicit drugs (e.g., body packing). Core competence in addiction medicine includes the ability to make accurate diagnoses, initiate treatment, and plan and coordinate services. Some hospitals have specialized addiction consultation services, but there is a shortage of board-certified addiction psychiatry specialists. All psychiatrists working in general medical settings are on the front lines of substance abuse and must be sufficiendy knowledgeable. The Read more […]

Effects of Methamphetamine Use

Cerebral Injury and Death from Methamphetamine Use The cerebral damage caused by methamphetamine intoxication can be formidable. Prolonged use is associated with injury to the dopamine system. Essentially, continued methamphetamine use likely leads to axonic degeneration of the dopamine axon terminals in the striatum, frontal cortex, nucleus accumbens, and amygdala. Hypersensitization of neurons occurs, for example, in increasing sensitivity of D-1 receptors. It is important to note that changes in catecholamines alone cannot explain behavior in humans when they are methamphetamine intoxicated. Animal studies across several species demonstrate that high dosages of methamphetamine damage nerve cells. In rats, one high dose is enough to cause damage to neurons; prolonged administration increases the number of neurons that are killed off. In squirrels, a single dose of MDMA (which is structurally similar to methamphetamine and mescaline) in only slight doses significantly damages brain neurons that produce serotonin. Twelve to 18 months after exposure, serotonin-producing nerves grow abnormally or not at all. MDMA selectively damages serotonin neurons in virtually all species. Buffenstein et al. showed through SPECT Read more […]