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 […]

Cocaine Abuse: A Review of Current and Experimental Treatments

Cocaine abuse is a recently revived drug problem that is again generating great popular concern. Unfortunately, scientific evaluation of cocaine abuse treatment has been surprisingly sparse kind no consensus exists regarding optimal treatment strategies. This review summarizes current treatment issues and regimens. as well as preliminary data on new, approaches to cocaine abuse treatment. Since this chapter will deal with treatment of the cocaine abuser, it is important from the outset to define what is meant by that term. Although in some settings any use of illegal drugs equals abuse such a definition is more legal than medical and will not he used here. Instead the definition of drug abuse found elsewhere in the field will be employed namely…“the nonprescription use of psychoactive chemicals by an individual to alter his her psychological state in a situation in which the individual or society incurs some harm” (). The great majority of cocaine users applying for treatment fit into this definition. The most common exception is the individual who defines his use as recreational controlled and nonharmful but is brought to treatment by another (e.g. spouse, parent), while the significant other views the cocaine 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 […]

Methamphetamine and the Courts: Mitigation in Sentencing

In the eyes of many, substance abuse is a matter of personal poor judgment in decision making. In spite of significant popular and scientific literature suggesting that addiction is a condition that has at least some organic and genetic inputs, having a drug or alcohol problem still equates with having a character deficiency. The law reflects this not uncommon perspective in that “being under the influence” of mind-altering substances is not exculpatory unless involuntary ingestion is involved. Furthermore, as is seen below, substance abuse may lead to enhancement of sentence severity. However, substance abuse has also been mitigating for sentencing purposes, ranging from an explicit affirmative defense in California of “diminished actuality” to nebulous so-called “waste-basket” mitigation clauses that permit the defendant to raise any factors of possible consequence. Forensic evaluation focused on the sentencing phase thus takes place in a complex and often uncertain legal context. Statutory and Case Law Relative to Substance Abuse and Mitigation in Sentencing Methamphetamine and the Courts: Evaluation of Defendants and Context Reporting to the Court In general, forensic reports follow a format of identifying information, Read more […]

Statutory and Case Law Relative to Substance Abuse and Mitigation in Sentencing

Two major levels of consideration pertain when it comes to sentencing schemes. One involves state codes and the case law that defines and guides their implementation by judges. The second is the federal law and a very special ongoing operation that has created a complex but not particularly flexible decision-making process. Aspects of how these levels operate with respect to substance abuse, particularly methamphetamine abuse, and sentencing are detailed below. State Codes and Cases In the state sentencing processes, somewhat greater potentials for mitigatory findings are evident. Cases in Ohio from 1997 to the present that have had appellate review were accessed. Table Methamphetamine and Sentencing: Ohio Appeals 1996-2002 Cases provides information regarding the types of cases, issues involved, and outcomes. Table Methamphetamine and Sentencing: Ohio Appeals 1996-2002 Cases Citation Type Major Issue Outcome State ex rel, ‘Wright v. Ohio Adult Parole Authority 75 0S3d 82 661 N.E. 2d728, 1996 Revocation of conditional release Restrictions in search and seizure; under prior precedent unreasonably obtained evidence not admissible Evidence obtained unreasonably is admissible State v. Cossin Read more […]

Methamphetamine and the Courts: Evaluation of Defendants and Context

Purposes of Evaluation All forensic evaluation and analysis takes place within a legal context and properly focuses on the questions before the court. As the foregoing section illustrated, there are relevant precedents that constrain both questions and variables, which may be entertained by the court. It is within that context that evaluation takes place. Mitigation in sentencing involves the notion that some agreed-upon level of punishment for the crime committed can be adjusted in the direction of leniency if factors particular to the person and situation warrant such consideration. Mitigation is a basic part of all legal codes and has been present either in content (by defining offenses according to some set of standard factors to be greater or lesser) or by reference to modifying conditions (the Code of Hammurabi written about 1700 B.C.e. contained such specifics) (). More currently, the resurrection of capital punishment after Furman (1972) created sets of definitions of mitigatory factors and a body of case law further elaborating what could or should be brought to the attention of the jury or judge. Following Lockett v. U.S (1978), inclusion of individually based information resulted in drug related factors Read more […]

Survey of Methamphetamine Cases Evaluated in a Court Clinic

Although assessment and treatment options in the county from which the below cases were reviewed are better than many, they are generally available only to defendants for whom a mandatory prison sentence is not involved. The general inclination of judges at this court is to refer whenever they perceive questions about treatment-related issues. It is the impression of the court psychologist that defendants referred for a pre-sentence psychological evaluation often are seen as having greater potential for treatment than incarceration. The focus for psychological evaluations as the psychologist reported it is to develop information relevant to the mitigation and sentencing issues and to the risk of violation of probation where a treatment package is recommended. In his opinion, further evaluation of the substance-related and other treatment aspects of referred defendants should be a component of any ongoing treatment facility. The major sources of referral are the judges on their own initiatives, motions by defense counsel, or the request of the probation department where initial psychosocial history leads to a question of psychological status. The majority of referred persons with substance-related issues attend Read more […]

Methamphetamine and the Courts: Treatment as a Sentencing Consideration

Although substance abuse in general and methamphetamine abuse in particular have given rise to sentencing enhancement rather than leading to a primary focus on recidivism prevention, the importance of intervention has not been lost in the criminal justice system. Toward that end, as was seen in the review of court cases above, recommendations for treatment as part of probation or conditional release are not uncommon. However, reaching a goal of reducing addictive behavior and the crime that is associated with it depends on having adequate treatment modalities. Treatment for chemical dependency in general and specifically for methamphetamine has not been uniform around the country. There have been a number of attempts through the National Institute on Drug Abuse (NIDA) and American Society for Addiction Medicine (ASAM) to develop standardized treatment protocols that would act as guidelines to programs that treat addiction. However, the penetration of these algorithms in the provider community has been at best sporadic and fragmented. Many providers continue to use a traditional approach to treatment that is primarily based on the disease concept and follows the Hazleton model. This approach, although effective for Read more […]

Methamphetamine and the Courts: Expert Testimony

U.S. Supreme Court Decisions Regarding Methamphetamine A search for U.S. Supreme Court cases involving methamphetamine usage reveals a decidedly conservative stance, although dissenting opinions reflect support for defendants’ and Constitutional rights. The few cases uncovered involved sentencing guidelines, entrapment procedures, waiver of plea bargain discussion inadmissibility and coercion in the plea bargaining process, hearsay evidence, and the right to cross-examination. For example, in Fowner v. United States (1992), the Court upheld the lower court’s ruling that sentencing based on the amount of a drug could reflect not just the amount for which the defendant was found guilty but also additional material that constituted a nondrug waste product. Similarly, in Kinder v. United States (1992), the lower court was upheld in applying a sentence that reflected an amount of a drug that the defendant had referred to in the course of discussions but was higher than the amount specified in the plea bargaining that allowed a conviction. Significant issues arise in the area of entrapment. Investigation of conspiracies to manufacture and sell drugs often involves undercover work and so-called sting operations. In Read more […]

Methamphetamine: Addiction Treatment and Recouery

Addiction experts report that an addiction to stimulants, especially a dependence on methamphetamine, can be very difficult to overcome. Those who are addicted to stimulants enjoy the euphoria that the drugs bring them, and to the addict, the highs of stimulant use are worth nearly any cost. As a result, the therapist must teach the addict to detach the joys of life from the use of methamphetamine and amphetamine, helping them learn that experiencing normal life with its ups and downs is a better way to live than depending on the feelings that stimulants induce as well as the many negative consequences that addiction can cause to their minds and bodies. When individuals are treated for amphetamine abuse or dependence, there is no physical need to taper off the drug, as there is with some other drugs, such as benzodiazepines, and thus, the drug can be stopped immediately. However, the psychological impact is profound. For example, psychological symptoms peak within two to four days of the last use of amphetamine and many users have very depressed mood and talk about suicide. Such severe reactions may require that the individual be admitted to a treatment facility and closely watched. Benzodiazepines (antianxiety medications) Read more […]