Cannabis Smoking in Teenagers

Cannabis smoking disrupts the hormonal balance in both men/boys and women/girls. We do not know exactly how this affects teenagers, but the suspicion is that it can reduce fertility. There have been reports of disturbance in growth and of delayed sexual maturity. Cannabis as a gateway to harder drugs: It has long been understood that cannabis use is one of several factors that increase the likelihood of starting to use other illegal drugs. One of the reasons for assuming there to be a causal connection has been that the intensity and duration of a person’s cannabis smoking increase the risk that he or she will move on to harder drugs. Notwithstanding this, it is only recent and methodologically well-conducted studies (including prospective ones of long duration covering a large number of people) that have been able to show that, even after controlling for the effects of other known and suspected factors, there remains a strong association between cannabis smoking and moving on to harder drugs. It would appear that we are close to proving the controversial gateway hypothesis – the hypothesis that, in many cases, cannabis use constitutes a gateway to harder drugs. The development of identity, according to accepted Read more […]

Does Cannabis Abuse Represent a Gateway to Harder Drugs?

The question of whether cannabis represents a gateway to harder drugs has occupied clinicians and researchers for 30 years. The reason for the interest in this question has been that a transition to harder drugs – heroin, amphetamines or cocaine – represents a significant increase in the degree of risk to which the individual is exposed. Even though cannabis is more psychotoxic than heroin, intravenous heroin abuse is in many other respects a considerably more serious condition than cannabis dependence. With heroin – which is also much more expensive than cannabis –, addiction not infrequently develops quickly, the dependence is strong, and mortality is considerably higher, mainly owing to overdoses. It is the rule rather than the exception that heroin-dependent individuals become socially marginalised. The abuse of both amphetamines and cocaine (not least in the form of “crack”) also leads to rapid development of severe dependence, with the risk of a series of mental side-effects and high mortality levels. Moreover, transition to intravenous abuse adds the risk of HIV infection. The most extensive studies in this field have been carried out by Denise Kandel and her research team. They showed, at an early Read more […]

The Functions of Marijuana

For adolescents the heavy use and abuse of all drugs involves the significance of the act of taking the drug as well as the specific functions of a particular drug for the youngster. It is reasonable to assume that any adolescent behavior strongly disapproved of by parents, teachers, and community leaders will reflect certain “antiauthority” overtones; certainly this appeared true of the representative cases of marijuana abusers. At the same time, our research indicated that past emphasis on heavy marijuana use as part of a lifestyle choice involving role modeling and affiliation with proponents of alternative social values, attitudes, and mores is unidimensional and overly simplistic. These adolescents’ involvement with drug-abusing peers waxed and waned in accordance with their changing need to smoke large amounts of marijuana. This need, while expressed in interaction with drug-abusing peers, related essentially to the psychodynamics of the youngsters’ family relationships. Defiance and provocation With someone like Dave, who grew marijuana plants in his basement, and who fought constantly with his parents over his right to smoke as much marijuana as he pleased, the provocativeness is apparent. Marijuana Read more […]

Cocaine: Short-term observations of users (1970-1983)

A number of studies have provided observations of contemporary patterns of cocaine use in the period 1970 to 1983. These studies have concentrated on selected populations of users that were seen at only a single point of time during this period. When reviewed chronologically, these observations suggest that patterns of cocaine use were changing rapidly throughout the period 1970 to 1983 and in particular for long-term users. For individuals engaged in continued use this change was characterized by increased dosage and frequency of use resulting in decreasing positive effects and increasing negative reactions including physical and psychological dysfunction. This changing pattern is also examined () in a series of longitudinal observations made on a sample of users studied at multiple points of time during this sane period. Users entered the 1970s with attitudes that supported their beliefs that cocaine was a “safe recreational drug.” Gay and Inaba () suggested that the rediscovery of cocaine in the 1970s was inevitable because its effect of euphoria and stimulation “reinforces and boosts what we recognize as the highest aspirations of American initiative, energy, frenetic achievement, and ebullient optimism” (). Phillips Read more […]

The Theoretical Basis of Narcotic Addiction Treatment with Narcotic Antagonists

The theoretical basis of narcotic addiction treatment with narcotic antagonists was well stated by Martin et al. (). Briefly, outpatient maintenance of a previously detoxified opioid addict on a daily oral opioid-blocking dose of a narcotic antagonist is expected to accomplish two objectives: (a) to remove the incentive for seeking and using opioid drugs; and (b), to extinguish conditioned abstinence (including “craving”) should this phenomenon occur as a response to environmental stimuli to which unconditioned abstinence had previously become conditioned (). Needless to add, such a period of out-patient maintenance on a narcotic antagonist should be used to “rehabilitate” the patient – i.e., to train him in the skills necessary for holding a socially useful job. to form new, mutually supportive relationships with non-drug using persons, and to persuade him to give up the illegal “hustling” activities which had become self-reinforcing during previous periods of opioid addiction. Such a period of out-patient maintenance on a narcotic antagonist would have advantages over detoxification followed by enforced abstention from opioids (by prison sentences with or without a subsequent probationary period) in Read more […]

A Point of View Concerning Treatment Approaches with Narcotic Antagonists

When narcotic antagonists were first introduced into the treatment of drug addiction, patients were placed on the medication without regard to selection criteria and assessments of “successes” or “failures” were made only on the basis of their retention in the program. Since that time, however, our evaluation criteria have become more refined and we have begun to look at more complex questions such as: Are these compounds “helpful” and if so, “for whom” and by what treatment techniques can we augment their usefulness? A salient aspect of our naltrexone studies, for example, is addressed to the question of “for whom?” Hopefully when our data analysis is completed, it will contribute to either affirming or negating the conceptual model that we have formulated to aid us in the differential diagnosis and treatment of opiate dependent individuals. For my presentation today I have chosen to share with you some aspects of our point of view concerning treatment approaches based on our clinical experience. As investigators, we are all committed to the rigors of science with its demand for carefully controlled data. However, I am not addressing myself to specific research data, but rather to some issues concerning the application 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 […]

Studies of Acute Alcohol Effects in Women and Animal Models

Alcohol Effects on Basal Hormone Levels Another approach to examination of alcohol’s toxic effects on reproductive function is to administer a single acute dose of alcohol to a normal healthy woman or experimental animal and measure the effects on pituitary and ovarian steroid hormones. Through a systematic manipulation of alcohol dose and changes in hormone levels, it should be possible to establish whether alcohol primarily disrupts hypothalamic, pituitary, or ovarian function. Surprisingly, studies of acute alcohol administration have shown that alcohol has minimal effects on basal hormone levels. Alcohol did not significantly suppress LH or estradiol in normal women or in female macaque monkeys. These data suggest that a single episode of intoxication is probably not sufficient to suppress normal basal hormone levels and that repeated episodes of intoxication are required to produce the hormonal correlates of amenorrhea, anovulation, and luteal phase dysfunction observed in clinical studies. One procedural difficulty affecting all investigations of acute alcohol effects on basal hormone levels is that studies have usually been conducted during the early follicular or luteal phase of the menstrual cycle, when basal Read more […]

Adverse Effects of Cocaine Abuse

Specific, consequences of cocaine abuse on health and psycho-social functioning were assessed in 55 cocaine-abusing subjects who called a telephone “helpline.” Results showed a high incidence and wide range of adverse consequences including: (a) impairment of job functioning, interpersonal relationships, and financial status; (b) disturbances of mood and cognitive functioning; (c) psychiatric symptoms of depression, paranoia, and increased suicidal/violent tendencies; and (d) physical symptoms of exhaustion, weight loss, sleep problems, and seizures. Cocaine-related automobile accidents, suicide attempts, and violent acts, including a cocaine-related homicide, were also reported. Intranasal users reported no fewer and no less severe adverse consequences than free-base smokers or intravenous users. Our findings challenge popular notions that cocaine is a benign “recreational” drug and that the intranasal route of administration guarantees protection against addictive patterns of use and adverse effects. Introduction Cocaine use has escalated to epidemic proportions in the U.S. in recent years. Nationwide surveys estimate that over 22 million American have used cocaine and the numbers continue to soar at an alarming Read more […]

Multiple Drug Use Epidemiology, Correlates, and Consequences

The initial focus is on the conceptual issues essential to the understanding of multiple drug use. This is followed by a discussion of the developmental nature of multiple drug use and the various strategies that have been designed to measure multiple use. The third section of the paper contains a review of the extent of multiple drug use in various segments of society with data from the Monitoring-the-Future surveys of high school seniors, the National Survey on Drug Abuse, and the Treatment Outcome Prospective Study of drug abuse treatment clients. The conclusion is that multiple drug use is pervasive. The next section deals with several consequences associated with multiple drug use: automobile accidents, delinquency, and emergency room visits. The final section outlines some of the prevention and treatment implications of multiple drug use from a public policy perspective. In a study of the effects of a single drug upon behavior, the implications are manifold. Dosage levels, modes of administration, baseline states, the expectations of the subjects and of the investigators, the environment in which the drug is taken — all these variables, and others as well, make human psychochemical studies difficult and complex. Read more […]