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 […]

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 […]

Cocaine abuse treatment strategies

Strategies devised to treat cocaine abuse have existed since its intractable lure for some first became obvious almost a century ago. During this period no generally accepted or successful treatment has emerged. Chronic cocaine abuse has been assumed to cause no physiologic withdrawal state on discontinuation because of insufficient evidence for an abstinence syndrome of major physiological changes like the classic sort characterizing sedative or opiate withdrawal (). Cocaine abuse has thus been assumed to be a “psychological dependence” rather than one involving neurophysiological adaptations, and currently used treatments consist of psychological strategies aimed at modifying addictive behaviors. Issues related to current psychological strategies will be discussed first, followed by a summary of evidence indicating cocaine abuse may cause neuroadaptation. The latter includes a review of pharmacological strategies, aimed at reversal of such adaptation, which may hold future potential as adjuncts in cocaine abuse treatment. Cocaine abuse treatment strategies: Current treatments Potential New Directions in Treatment Despite the past assumption that cocaine abuse is a “psychological addiction,” it is plausible Read more […]

Cocaine abuse treatment strategies: Current treatments

Only two comprehensive efforts at cocaine abuse treatment are described in the modern literature. Both are nonpharmacological, but each involves a very different approach to treatment. Anker and Crowley () have adapted the behavioral method of contingency contracting () for cocaine abuse. The contract involves such contingencies as the therapist’s holding letters of notification of cocaine abuse or resignation of professional licenses, written by the patient with content chosen specifically because of severe irrevocable personal effects, and mailing them to drug enforcement authorities, employers, or licensing boards upon finding evidence of cocaine use in urinalysis or after missed urinalysis. Such treatment appears to effectively induce abstinence in those willing to take part. Anker and Crowley report 48% of their sample were willing to engage in this treatment, with over 90% cocaine abstinence during the duration of the “contract.” Over half of these patients relapsed following completion of the “contract” (), however, even though the sample was a presumably well motivated and well educated group. The patients declining “contracts” (52%) were treated with supportive psychotherapy which was also used as 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 […]

Medical Consequences of the Use of Cocaine and Other Stimulants

Once thought to be a benign, nonaddicting drug, cocaine now has well-recognized adverse effects. These adverse effects are manifested in nearly all organ systems of the body. It is important to realize that an organ system breakdown in classifying the adverse effects of cocaine is artificial and that multiple organs are often affected by similar mechanisms. In particular, the effects of cocaine on the cardiovascular system help to explain many of the effects on other organs throughout the body. In addition, certain adverse effects may be dependent on the route of administration, or dose of cocaine. The adverse effects of two other stimulant drugs, methamphetamine and phenylpropanolamine, will be summarized at the end of this post. History The history of cocaine use has been well described by a number of authors. Peruvian Indians have a long history of chewing coca leaves to achieve euphoria, combat fatigue, and increase stamina. Sigmund Freud used cocaine and also prescribed it as treatment for alcohol or opiate addiction. At one time, cocaine was a common ingredient in many commercial products, including teas and patent medicines. Although no longer the case, when first introduced, Coca-Cola was formulated using Read more […]

Regional Variations in Use of Drugs

Data on the Locations where men were Living at the time of the interview became available late in the process of preparing this report. The computer tape has not been checked with the interview schedules, but it is known that the Location of one respondent is Listed incorrectly. Consequently, data are available for 2,509 rather than 2,510 men. The importance of the available data justify inclusion of a brief discussion of regional variations. Data on the Lifetime use of all drugs except tobacco and alcohol are presented in Table “Lifetime Drug Use by Regions and Divisions of U.S. in Which Respondents Lived at Time of Interview (Percentages)” in terms of the four regions and nine major divisions of the United States. The percentages for the regions are offset and enclosed in parentheses to facilitate comparisons. For five of the drugs the rank order of the regions is the same; the West had the highest percentage, and was followed by the Northeast, North Central and the Southern regions. This pattern was observed for marihuana, psychedelics, stimulants and sedatives; it also held for cocaine, as the apparent tie between the North Central and Southern regions disappeared when an extra decimal place was used. Read more […]