Cocaine: Longitudinal study of users (1975-1983)

Methods A total of 118 cocaine users were recruited for study in 1974. Of these, 19 were selected for interview and questionnaire study while 99 (85 males, 14 females) were selected for a more comprehensive longitudinal study. All 99 users (18-38 years old) were social-recreational users who met the initial requirement of having used a minimum of 1 gram of cocaine per month for 12 months (range 1-4 grams). The majority of users were students (73 percent,) while others listed their occupations as housewives, business people, writers, attorneys, physicians, secretaries, teachers, or unemployed. Exaninations and tests were performed on each subject at 6-month intervals for 4 years (1975, 1976, 1977, 1978) and then at approximately 18-month intervals for another 5 years. Examination procedures included a personal history questionnaire, drug history questionnaire, subjective drug effects questionnaire, mental status exanination, the Minnesota Multiphasic Personality Inventory (MMPI), the Experiential World Inventory (EWI), in-depth interviews, and physical examinations (for most subjects). In addition, assays were performed on samples of cocaine used by these subjects. An important caveat is that a number of users dropped Read more […]

Human Dependence on Tobacco and Opioids: Common Factors

Recent years have seen increasing acceptance of the notion that tobacco is an addictive or dependence-producing substance, particularly as it is used in cigarette smoking. This idea is supported by the observations that tobacco serves as a reinforcer (i.e., it maintains behavior leading to its use) and that most people who smoke cigarettes would like to quit but cannot, even in the face of well documented health risks and economic sacrifices (Surgeon General’s Report 1979). The term “drug dependence” suggests that (1) the drug serves as a reinforcer, (2) behavior occurs which is maintained by the opportunity to take the drug, and/or (3) other reinforcers are sacrificed as a consequence of taking the drug (). Many cigarette smokers in some degree satisfy these criteria for drug dependence (). Since cigarette smoking has only recently been conceptualized as an instance of drug dependence, it should be useful to systematically compare cigarette smoking with another more thoroughly studied dependence process such as opioid dependence or narcotic addiction. At first blush, cigarette smoke and opioid drugs appear to produce vastly differing pharmacological and behavioral effects: large doses of opioids can produce 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 […]

Alternatives to Drug Abuse: Some Are and Some Are Not

The purpose of this paper is to discuss the current state of the art of alternatives to substance abuse as one of several approaches to prevention. This paper defines four different approaches to prevention that have been proposed and reviews the literature related to each approach. Two recent studies of alternative programs and activities will be presented and the paper will conclude with recommendations for further research. The concept of alternatives to substance abuse was one of the first responses to the problem (). The early advocates of this strategy recommended substituting positive experiences for the experiences reported to be associated with substance abuse. Some early workers in the field were aware that not all alternatives would automatically provide an acceptable substitute for some of the pleasures sought and perceived by drug-using and-abusing individuals. For example, Swisher and Horman () discovered, upon completion of a program for college student leaders, that one individual had been very impressed by the emphasis on alternatives; and even though he was only an experimenter with some drugs, he decided to pursue a viable alternative–skydiving, which may have been a greater health risk. Four 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 […]

The Mexican Experience: Fight Against Consumption

Epidemiology But Mexico is not only a drug-exporting country. A number of complexly interrelated factors have accounted for an alarming increase in domestic consumption. Estimates show that the problem is essentially an urban one. In rural areas, although one can find certain towns where drugs still are employed in religious rituals or simply as an element in the subculture of the group, drug abuse as such is not considered a problem that affects public health. The majority of urban drug abusers range in age from 12 to 21 years. The younger set uses inhalants and solvents, while the older group usually uses marihuana. It seems certain that the use of barbiturates and amphetamines is on the increase. Barbiturates and tranquilizers are preferred by young adults. At present there is a problem of hard drugs such as opium and its derivatives among a group along the northern border of the country, where an increase has been observed in the number of Mexicans taking heroin (). The highest percentage of drug experimentation and use appears to be among preadolescent and adolescent males and young adult females. In general, however, lower-class youths tend to use industrial-type solvents, which are cheap and easily Read more […]

A Review of Drug Abuse Data Bases

This chapter will identify and describe briefly data sources which may be used to project nonmedical drug use among young adults in future years. A wide variety of sources have potential utility in this regard. They range from individual studies conducted by local school districts or States to major national surveys involving thousands of respondents. Because of the proliferation of research on drug use in recent years, it was necessary to place some limitations on the data to be presented here. First, it was decided that since a complete review was conducted in 1974 (), it was unnecessary to duplicate those efforts. () The studies reviewed here are more recent and, with the exception of the earliest National Surveys, were not covered in the 1974 review. Second, this review is limited to those data bases which are national in scope. State and local surveys have severe limitations for purposes of making national projections of nonmedical drug use. For example: 1. The definitions used for nonmedical use often vary from one local or State survey to another. 2. Various local and State surveys are conducted in different time periods, so that it is often difficult to piece together a national profile. 3. The Read more […]

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 […]