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 […]

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 […]

Alcohol-Related Disorders

Workers in the addiction field have attempted to more clearly define alcohol use problems, and accuracy is especially important for making a diagnosis in a medical setting. Several hospitalizations for alcohol-related illness can occur before a direct connection is made between a patient’s alcohol use and medical problems. Alcoholic patients tend to experience many alcohol-related problems before seeking professional help or attending AA meetings. Stigma associated with the term alcoholism frequently inhibits physicians and patients from exploring the connections between abuse and biopsychosocial consequences. Psychiatrists participating in a hospital survey positively identified alcohol abuse two-thirds of the time, whereas physicians treating gynecology patients diagnosed the disorder only 10% of the time. In primary care settings similar underdiagnosis is common; however, in studies that rely on chart review or screening instruments, investigators may underestimate what physicians really suspect to be the case. The official psychiatric nomenclature for alcohol abuse and dependence evolved from the view of alcoholism as a personality disorder (American Psychiatric Association 1952), through recognition of episodic, 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 […]

Pharmacology of Flunitrazepam and Other Benzodiazepines

Benzodiazepines, therapeutically used as tranquilizers, hypnotics, anticonvulsants, and centrally acting muscle relaxants, rank among the most frequently prescribed drugs. Since Sternbach’s synthesis in 1955 of the first benzodiazepine by unexpected ring extension of a quinazoline-S-N-oxide derivative, a number of structurally similar compounds have been marketed by drug companies. Chlordiazepoxide (Librium®) was the first medical benzodiazepine, introduced in 1960, followed in 1963 by diazepam(Valium®) and in 1965 by oxazepam (Serax®). More than 50 of these drugs are presently marketed for clinical use throughout the world; 35 are subject to international control under the 1971 Convention on Psychotropic Substances. From International Narcotic Control Board (INCB) statistics, the most significant benzodiazepines in the last decade have been diazepam, lorazepam, alprazolam, temazepam, chlordiazepoxide, nitrazepam, triazolam, flunitrazepam, and lormetazepam. In this post dealing with the chemistry, pharmacokinetics, and pharmacodynamics of benzodiazepines, we focus mainly on flunitrazepam (). Flunitrazepam was first introduced on the market in 1975, in Switzerland, under the trade name of Rohypnol®. It is indicated Read more […]