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 […]

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 […]

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 […]

Outpatient Treatment and Outcome of Prescription Drug Abuse

Forty-six consecutive patients who voluntarily sought outpatient treatment for abuse of one or more prescription drugs were studied. Barbiturates, amphetamines, and diazepam were the most common drugs abused. Desired treatments by patients included counseling, medical withdrawal, or medical maintenance with the drug of abuse or a chemically related drug. Twenty-two (47.8 percent) patients left treatment and relapsed within one month; another eight (17.4 percent) patients relapsed between one and three months after entering treatment. Only 13 (28.3 percent) reported abstinence 90 days after entering treatment. This experience suggests that a wide range of medical, social, and psychologic resources are required to treat prescription drug abuse, and that long-term drug abstinence is difficult to achieve with all patients. Treatment of prescription drug abuse has dealt primarily with drug complications such as overdose, toxic reactions, and techniques for medical withdrawal. Other reports describe behavior patterns of prescription drug abuse and often refer to it as poly-drug abuse, since many persons frequently abuse more than one drug. Some reports emphasize the clinical complexity of poly-drug abuse and particularly Read more […]

Sedative-, Hypnotic-, and Anxiolytic-Related Disorders

Abuse and Dependence Sedative-hypnotic and alcohol intoxications are similar in symptoms and complications. Because sedative-hypnotic use is so frequent in hospitalized patients, the detection of sedative abuse can be difficult. Abuse rarely starts as a result of treatment of acute anxiety or insomnia in a hospitalized patient. The risk of sedative abuse in chronically medically ill outpatients is far greater. There are three major classes of benzodiazepine abusers: polysubstance abusers, pure sedative abusers, and therapeutic users who have lost control. Individuals prone to polysubstance abuse tend to use sedatives for their calming effects (i.e., to come down after use of a stimulant such as cocaine) and for their ability to decrease dysphoric affects, including anxiety, or to potentiate euphoric effects of other drug classes (e.g., benzodiazepines in combination with methadone to boost euphoria). Pure sedative abusers usually have significant underlying psychopathological conditions, and relapse is common. In a long-term follow-up study involving subjects with primary sedative-hypnotic dependence, 46% of the subjects continued to abuse drugs after in-hospital rehabilitation treatment. Anyone can develop physiological Read more […]

Medical Aspects of Benzodiazepines: Intrinsic Safety

From the medical viewpoint, the availability of any drug must be based on a judgement of its therapeutic value compared with its safety. Therapeutic benefit exists when the level of improvement achieved exceeds the danger; this ratio must be related to the disease being treated. When the drugs with potential dependence liability are considered () it will be seen that the range of diseases for which they are used is wide. Thus, for example, the narcotic analgesics are the only effective drugs for the relief of the pain experienced in some terminal diseases and the availability of at least some powerful analgesics is important for this use. This, however, does not imply that they should be used medically for the relief of minor pain for here the dependence risk exceeds the benefit. The hallucinogens cannabis and cocaine on the other hand have considerable dependence liability, sometimes coupled with other medical risks but no therapeutic merit and their availability cannot be justified medically. A similar situation exists for the amphetamines in terms of dependence liability and if the rare cases of hyper-kinetic syndrome are excluded, the amphetamines have no therapeutic merit and should therefore not be used. The Read more […]

The Level of Benzodiazepine Dependence Risk in Humans

It is clear from the human experiments conducted by Hollister and others that if benzodiazepines (like most if not all psychotropic drugs) are given in large enough doses for a long enough period, physical dependence can result. It is equally clear from the observations reported on pp. 23 to 40 that dependence can also occur occasionally under conditions of abuse and when benzodiazepines are used medically. It is important to try to assess the level of risk and particularly the level relative to other central nervous system active drugs. The concept of a dependence-producing ‘capacity’ or ‘potential’ which resides in a drug itself has been questioned by some authorities in respect of drugs other than narcotics. These authorities suggest that it is more relevant to speak of ‘dependence-prone individuals’ who abuse a variety of substances and can develop dependence upon any or all of them (see, for example, Edwards). Keilholz writes of a multiple determination in which the drug is only one of the elements, the others being the individual himself and the setting. If the contributory role of the pharmacological action of drugs is accepted, it is now widely agreed that compared to the amphetamines and the barbiturates, Read more […]

Benzodiazepine Dependence: Animal Studies

Animal models are available for the production of both psychological and physical dependence. The most important animal model for the study of psychological dependence is the operant model using an intravenous self-administration technique originally used for opiate studies (see for example references-) . The animal is trained to self-administer the drug solution through an indwelling cannula by pressing a bar which activates the injection pump. The literature, particularly that relating to opiates has been extensively reviewed and is beyond the scope of this paper. These studies have shown that different groups of drugs have different levels as operant reinforcers. Thus opiates, amphetamines and cocaine are highly potent, ethanol and barbiturates moderately so and mescaline and phenothiazines relatively ineffective. Not all animals of the same species respond to reinforcement in the same way but some develop drug intake patterns which, like those of dependent humans, lead to physical illness and gross withdrawal reactions. In such experiments benzodiazepines have shown negligible evidence of dependence production. Thus Findley, Robinson and Peregrino studied the effect of intravenous administration of chlordiazepoxide Read more […]

Types of Drug Dependence

The WHO expert committee has recognized that different groups of drugs produce different types of dependence and that the type should be specified. The currently accepted types, the main classes of drugs involved and the clinical characteristics of the dependence are shown in Table Dependence types currently recognized and their clinical features. Apart from noting the great variety of types that are now recognized, the majority of classes can be ignored for the purpose of the present paper and attention can be concentrated on the groups of ethanol and barbiturate/sedative. There are still divergent opinions on whether they should be grouped together, for both show psychological and physical dependence with virtually identical withdrawal reactions, or whether they should be separated. In favour of their being put into a single group is the extensive cross tolerance that can occur among drugs with similar actions, regardless of chemical structure, and the partial effectiveness of one group in ameliorating the withdrawal effects of the other. Thus, for example, severe ethanol withdrawal reactions can be prevented by barbiturates, phenothiazines, benzodiazepines, chloral hydrate and paraldehyde. Conversely ethanol Read more […]

A Brief Overview of Cultural and Historical Contexts

The persistent and widespread problem of methamphetamine misuse is shaped not only by the biology of addiction, but by historical and cultural contexts. Methamphetamine is a methylated derivative of amphetamine, which was first synthesized in 1887, by a German chemist. It was first synthesized from ephedrine in 1893, by a Japanese chemist. In 1919, methamphetamine was synthesized in Japan via reduction of ephedrine using red phosphorous and iodine. The first medical use for methamphetamine was marketed by Smith-Kline-French in 1928 as Benzedrine, used in inhalers sold over-the-counter for treating asthma. (Benzedrine led to the street name of “bennies.”). Amphetamines were subsequently found to be effective in treating narcolepsy, nasal congestion, weight gain, and attention deficit disorder, and for providing extended periods of wakefulness (Bender & Cottington, 1942). In the 1930s and 1940s, amphetamines were prescribed for schizophrenia, morphine addiction, and low blood pressure. During World War II, the armies of Japan, Germany, and the United States all provided amphetamines to military personnel to fight fatigue and enhance performance. Amphetamines also were used in Japan to improve the productivity of civilian Read more […]