Table of Contents
Preface xiv
Chapter 1 Drug Use and Misuse 3
Pharmacology and Drugs 5
Drug Classification 6
The Drug Experience 7
Alcohol and Drug Use in the United States 8
National Survey on Drug Use and Health 9
Multiple Drug Use 11
International Comparisons of Drug Use 12
Negative Consequences of Alcohol and Drug Use 14
Defining Harmful Drug Use 15
Use of the DSM 15
Drug Tolerance, Withdrawal, and Drug-Taking Behavior 18
Overview of the Text 21
Evaluating Websites 21
Summary 23
Chapter 2 Drug Use Yesterday and Today 27
Historical Overview 28
Drug Use in the United States 29
Medical Science and Drug Use 34
Development of Drug Laws 35
The San Francisco Ordinance 36
Pure Food and Drug Act 37
Harrison Narcotics Tax Act 37
Alcohol Prohibition 38
Post-Prohibition Legislation 39
Current Drug Laws 40
Summary 46
Chapter 3 Drugs and the Nervous System 51
The Neuron 52
Neural Transmission 53
Drugs and Neural Transmission 56
Major Neurotransmitter Systems 59
Acetylcholine 59
Monoamines 60
Endorphins 62
Amino Acid Neurotransmitters 63
Other Neurotransmitters 63
The Nervous System 63
The Brain 65
The Hindbrain 65
The Midbrain 66
The Forebrain 67
Imaging the Human Brain 69
Summary 71
Chapter 4 Pharmacology 75
Pharmacokinetics and Drug Dose 77
Drug Dose 77
Routes of Administration 78
Drug Absorption 82
Drug Distribution 85
Conclusion 89
Pharmacodynamics 91
The Dose-Effect Curve 91
Effective and Lethal Doses 94
Drug Interactions 96
Summary 99
Chapter 5 Psychopharmacology and New Drug Development 103
Factors Influencing Drug Effects 104
Biological Factors 105
Psychological Factors 106
Social and Environmental Factors 109
Tolerance 109
Types of Tolerance 110
Explanations of Tolerance 111
Behavioral Pharmacology 114
Reinforcement and Punishment 115
Operant Principles and Drug Dependence 116
Drug Discrimination 117
Conflict Paradigm 118
Animal Models and Human Drug Use 119
Human Behavioral Pharmacology 120
Ethical Questions 120
Placebo Controls 120
New Drug Development 122
Clinical Trials and FDA Approval 123
Distribution and Marketing 124
Generic Drugs 125
Summary 127
Chapter 6 Cocaine, Amphetamines, and Related Stimulants 131
The Coca Leaf 132
Early Use of Cocaine 134
The Amphetamines 136
Cocaine Epidemic II 137
The Return of Meth 142
Bath Salts 144
Pharmacokinetics of Stimulants 146
Mechanism of Stimulant Action 146
Acute Effects at Low and Moderate Doses 148
Physiological Effects 148
Behavioral Effects 149
Acute Effects at High Doses 150
Effects of Chronic Use 150
Acute Effects at High Doses 150
Effects of Chronic Use 150
Tolerance 151
Dependence 152
Stimulant Drugs and ADHD 153
Summary 156
Chapter 7 Nicotine 159
History of Tobacco Use 161
The West Discovers Tobacco 161
Tobacco as Panacea 162
From Panacea to Panned 162
Prevalence of Tobacco Use 163
Smoking in the United States 163
Initiation of Smoking 165
Smokeless Tobacco Use 166
Pharmacology of Nicotine 167
Sites of Action 167
Pharmacokinetics 168
Distribution 168
Metabolism and Excretion 169
Tolerance and Dependence 170
Tolerance 170
Physical Dependence 171
Acute Effects of Nicotine 171
Nicotine's Dependence Liability 173
Effects of Chronic Tobacco Use 173
Tar, Nicotine, and Carbon Monoxide 175
Diseases Linked to Cigarette Smoking 176
Other Tobacco Products and Health 177
Passive Smoking 178
Treatment of Cigarette Smoking 179
The Necessity of Formal Treatment 180
Treatment Effectiveness 181
Conclusions about the Treatment of Cigarette Smoking 183
Summary 186
Chapter 8 Caffeine 191
Sources of Caffeine 192
History of Caffeine Use 194
Prevalence of Caffeine Consumption 195
Pharmacology of Caffeine 198
Mechanism of Action 198
Pharmacokinetics 199
Tolerance and Dependence 200
Tolerance 200
Caffeine Withdrawal 200
Acute Effects of Caffeine 201
Behavioral and Psychological Effects 201
Interactions among Caffeine, Nicotine, and Alcohol 202
Acute Toxic Effects of Caffeine 206
Chronic Effects of Caffeine Use 207
Therapeutic Uses of Caffeine 210
Conclusions 210
Summary 211
Chapter 9 Alcohol 215
Alcoholic Beverages 216
Fermentation and Distillation 216
Expressing the Alcohol Content of a Beverage 217
History of Alcohol Use 219
Consumption of Alcohol and Heavy Drinking in the United States 221
Per Capita Consumption 222
Consumption of Alcohol among College Students 224
Pharmacology of Alcohol 226
Mechanism of Action 226
Pharmacokinetics of Alcohol 227
Tolerance and Dependence 231
Tolerance 231
Physical Dependence 232
Therapeutic Uses 232
Acute Effects of Alcohol 233
Physiological Effects 233
Sensorimotor Effects 236
Alcohol and Driving Ability 236
Psychological Effects 239
Alcohol and Behavior 239
Effects of Chronic Heavy Drinking 243
Alcohol and Brain Functioning 246
Alcohol and the Liver 247
Alcohol and Reproductive Functioning 248
Fetal Alcohol Syndrome 248
Moderate Drinking and Health 250
The Development of Alcohol Use Disorder 252
Traditional Approaches to Etiology 252
"Biopsychosocial" Approaches to Etiology 254
Summary 256
Chapter 10 Opiates 261
History of the Opiates 262
Early History 263
Opiate Use in the 19th Century 263
Opiate Use after the Harrison Act 265
The Making of an Epidemic 269
The Opiate Epidemic 270
Pharmacokinetics 272
Absorption 272
Distribution, Metabolism, and Excretion 272
Mechanisms of Opiate Action 273
Discovery of Endorphins 273
What Do Endorphins Do? 274
Medical Use of Opiate Drugs 275
Acute Psychological and Physiological Effects of Opiates 277
Chronic Effects of Opiates 278
Tolerance 279
Withdrawal and Dependence 280
Summary 281
Chapter 11 Marijuana 285
Historical Overview 287
Cannabis in the Americas 288
Committee Reports on Marijuana 291
Epidemiology 292
Methods of Use 295
Active Ingredients 297
Potency of Cannabis 297
Pharmacokinetics 297
Absorption 298
Distribution, Metabolism, and Excretion 298
Mechanisms of Action 299
Research Findings 299
Tolerance and Dependence 300
Medical and Psychotherapeutic Uses 301
History of Therapeutic Use 301
Current Status of Medical Uses of Marijuana 303
Physiological Effects 305
Acute Effects 305
Longer-Term Effects 305
Psychological Effects 308
Behavioral Effects 308
Cognitive Effects 309
Emotional Effects 310
Social and Environmental Effects 311
Summary 313
Chapter 12 Hallucinogens 317
Overview 318
Serotonergic Hallucinogens; LSD and Related Compounds 320
Early History 320
Recent History 323
Mechanisms of Action of LSD-Like Drugs 326
Pharmacokinetics of LSD-Like Drugs 327
Psychotherapeutic Uses 328
Effects of Serotonergic Hallucinogens 329
Adverse Effects of Serotonergic Hallucinogens 330
Methylated Amphetamines 333
Overview 333
History and Epidemiology 334
Effects of Methylated Amphetamines 335
Toxicity 337
Residual Effects of MDMA 337
Psychotherapeutic Uses 339
Anticholinergic Hallucinogens 340
Dissociative Anesthetic Hallucinogens 341
History 341
Pharmacokinetics 341
Effects of PCP and Ketamine 342
Psychotherapeutic Uses 342
Salvinorin A (Salvia) 343
Summary 344
Chapter 13 Psychotherapeutic Medications 347
Historical Overview 349
The Pre-Chlorpromazine Era 349
The Age of Chlorpromazine 350
Epidemiology 351
Classes of Drugs and Their Actions 354
Antipsychotics 354
Antidepressants 360
Antianxiety Agents 367
Nonbenzodiazepine Treatment 380
Mood-Stabilizing Drugs 380
Psychotherapeutic Drugs and Pregnancy 383
Summary 384
Chapter 14 Other Prescription and Over-the-Counter Drugs 389
Overview 390
Prescription Drugs 390
Birth Control Drugs 390
Anabolic Steroids 393
Over-the-Counter Drugs 398
FDA Classification 398
Analgesics 399
Cold and Allergy Medications 401
Over-the-Counter Stimulants and Sedatives 401
Herbal Products, Hormones, and Dietary Supplements 402
Areca (Betel) 403
DHEA 403
Ephedra/Ma Huang 404
Ginkgo Biloba 404
Kava 404
Kratom 405
Melatonin 406
S-Adenosyl-Methionine 406
St. John's Wort 406
Valerian 406
Gamma Hydroxybutyrate 407
Inhalants 408
Summary 410
Chapter 15 Treatment of Substance Use Disorders 413
Motivation to Change 415
Change without Formal Treatment 417
Self-Help Groups 417
Alcoholics Anonymous 418
Other Self-Help Groups 421
Models of Substance Use Disorders 422
Five Model Categories 422
Biopsychosocial Model 424
Professional Treatment: Assessment and Goals 425
Abstinence or Moderation? 426
Harm Reduction 427
Alcohol Treatment Settings and Services 428
Types of Settings and Services 428
Pharmacological Treatment 430
Effectiveness of Alcohol Treatment 431
Nonpharmacological Professional Treatment 432
Self-Help Treatment 433
Effectiveness of Pharmacological Treatments 436
Other Drug Treatment Settings and Services 438
Treatment of Nonopiate Drug Use Disorder 438
Pharmacotherapy of Other Drug Use Disorders 439
Effectiveness of Drug Treatment 441
Nonpharmacological Professional Treatment 441
Self-Help Treatment 442
Pharmacological Treatments 443
Promising Treatment Techniques 444
Special Topics in Alcohol and Drug Treatment 445
Treatment of Polysubstance Misuse 445
Treatment of Dual-Diagnosis Patients 446
Relapse 446
Models of Causes and Treatment Methods 450
Economic Factors in Alcohol and Drug Treatment 450
The Stepped-Care Approach 452
Summary 454
Chapter 16 Prevention of Substance Misuse 459
Defining Prevention 461
Models of Prevention 462
Sociocultural Model 462
Distribution of Consumption Model 464
Proscriptive Model 466
Principles of Drug Misuse Prevention 468
Current Topics in Prevention 470
Education and Mass Media Efforts 471
Affect-Oriented Programs 473
Alternative Behaviors and Resistance-Skills Training 474
Temperament-Based Interventions 475
Worksite Programs 476
Programs for College Students 477
Closing Comments on Prevention 480
Summary 481
Glossary 484
References 490
Index 529
