Index
A
benzodiazepines, 211
Abuse/use of drugs, terminology, 3, 16-17, 18-19, 95
Access to treatment, 193
HIV/AIDS care, 205-206
managed care systems, 231-235
Addiction. See Dependence
Addiction Severity Index, 201-202, 239
African Americans, 99, 110, 125, 126-127, 128
Age-based differences developmentally appropriate interventions in families, 150
drug-taking behavior, 96-99
life course of drug use, 108-109
Alcohol
agonist/antagonist therapies, 70, 71, 195
biochemical markers, 121
drug interactions, 173
drug-seeking behaviors in withdrawal, 66-67
extent of dependence, 102
intergenerational transmission, 119
neural substrate of withdrawal, 67-68
neurochemical reinforcement, 65
physiological protective factors, 121
prenatal exposure, 169-170
tolerance, 66
tolerance as etiological factor, 121
violence linkages, 177-178
Aldehyde dehydrogenase, 121
gamma-Aminobutyric acid (GABA), 58, 178
Amphetamines
neurochemical response, 64
neurotoxicity, 83
Animal models, 35
behavioral research, 37
drug abuse effects on course of HIV, 83
fetal drug exposure, 168
new drug development, 41
recommendations for research, 5, 87
relapse behavior, 69
Antiaddiction medications, 27, 29.
See also Pharmacotherapy
Antisocial personality, 123, 181
Anxiety disorders, 211
Arachidonic acid, 59
Assessment instruments, 201-202, 239
B
Barbiturates, 66
Behavioral research
in abuse liability research, 38-39
on aggression and violence, 47-48
behavioral models, 36-37
craving response, 46-47
economic modeling, 49-50
future prospects, 50-51
learning and conditioning in treatment models, 41-42
on motivation for drug use, 43-45
neuroscience research and, 37-38
for pharmacotherapies, 39-41, 203
risk factors for drug use, 48-49
on withdrawal, 42
Benzodiazepines, 211
antagonists, 70
Bromocriptine, 71
Buprenorphine, 195-196
C
Ca2+ neurotransmitter pathway, 59, 60
Cannabis. See Marijuana
Cerebral blood flow measurement, 73
Children/adolescents
antismoking campaigns, 145-146
community-based preventive interventions, 146
confidentiality issues in treatment, 270
consequences of prenatal drug exposure, 170-171, 174-175
developmental risks in drug use, 8, 166-167
epidemiological surveys, 99-101, 106
parental drug abuse, 175
peer risk factors, 125-126
predictors of adult substance abuse, 122-123
preventive intervention design, 140
racial differences in drug use, 128
risk factors, 128-129
school-based prevention programs, 141-143, 147-149, 152
treatment considerations, 214-215
Clorazepate, 211
Cocaine
aggressive behavior and, 47
antiaddiction medications, 203
brain glucose metabolism in use of, 73
craving response in users, 46-47
day hospital vs. inpatient treatment, 240-241
dopaminergic effects, 37, 64, 73, 82
drug interactions, 173
effects on male reproduction, 174
extent of dependence, 102
market characteristics, 260
maternal use during pregnancy, 166, 167
neurochemical response, 61, 64, 68
pharmacological antagonists, 70
prenatal exposure, 171-172
treatment vs. drug control/interdiction, 199-200
violence linkage, 178-179
See also Crack cocaine
Cognitive-behavioral psychology, 42, 196
Community Epidemiology Work Group, 105
Conditioned behavior, 41-42
in drug tolerance, 66
See also Reinforcement
Confidentiality issues
recommendations for research, 270
treatment program enrollment, 268-269
treatment-seeking behaviors of adolescents, 270
treatment-seeking behaviors of pregnant women, 269-270
Consequences of drug use, 159-161
fetal/child development, 166-175
gender differences, 212-213
health-related, 1, 7-8, 21-22.
See also HIV/AIDS
intensity of drug use and, 3, 18
violent behaviors, 8-9, 22, 176-182
Contingency contracting/management, 41-42, 196-197
Controlled Substances Act, 254, 257
Correctional systems
drug offender population, 263
treatment in, 213-214
Corticotropin releasing factor, 68
Cost-benefit analysis
drug control/interdiction vs. treatment, 199-200
managed drug abuse care, 227-228, 239-241
preventive interventions, 149
treatment, 198-200
treatment matching, 209
Cost-shifting, 243-244
Crack cocaine, 163
maternal use during pregnancy, 166
violent behavior and, 179
Craving, 46-47
Crimes/criminality
criminalization of drug users, 254- 255
drug abuse treatment for prisoners, 213-214
drug arrest/prosecution trends, 262-263
drug use in pregnancy as, 213, 269- 270
effects of criminal sanctions on drug use, 261-266
therapeutic role of criminal sanctions against drug use, 266- 268
Cyclic adenosine monophosphate (cAMP), 59, 60, 66, 68-69
Cyclic guanosine monophosphate, 59
D
Dependence
addiction and, 19
clinical features, 19
co-occurring psychiatric disorders, 82-83, 108
diagnosis, 192-193
epidemiological data, 101-102
goal of neuroscience research, 56
neurochemical systems in, 61-62, 65, 68-69
pain mechanisms and, 4-5
preventive interventions targeted
relapse risk, 19-20
vulnerability genes, 78-79
with co-occurring dependence, treatment for, 210
drug abuse treatment and, 16
Detoxification, 194-195
Diagnostic and Statistical Manual of Mental Disorders-IV,18, 19, 107, 192, 201
dependence diagnosis, 295-298
Diffusion-weighted imaging, 81
Domestic violence, 178
Dopaminergic system, 37-38, 62, 64-65, 67, 70, 71, 73, 76-77, 79, 82-83, 172
Drug, definitions of, 2-3, 16-17
Drug Abuse Reporting Program, 197-198
Drug Abuse Warning Network, 106
Drug control activities, 10-11
abuse reduction vs. medical use, 253-254
arrest/prosecution trends, 262-263
confidentiality of treatment programs, 268-269
cost-effectiveness, vs. treatment, 199-200
criminalization of users, 254-255
deterrent effects of criminal sanctions, 261-266
as drug abuse research topic, 250-251, 270-271
effects on illicit markets, 259-261
effects on legitimate drug use/research, 257-259
enforcement strategies, 255-256
epidemiological studies, 107
prohibition vs. discouragement, 252-253
recommendations for research on effects of, 259, 261, 268, 271
researchable issues, 251-252
severity of penalties, 256
therapeutic role of criminal sanctions, 266-268
treatment vs. punishment, 256-257
Drug discrimination model, 36-37
Drug effect expectancies, 41, 48-49
Drug self-administration, 3, 36, 48
abuse liability prediction, 38-39
craving and, 46-47
dependence and, 66-67
dopamine transport in, 37-38
for pharmacological therapy evaluation, 40-41
Drug testing, 113
Drug Use Forecasting Program, 103-104
DSM-IV. See Diagnostic and Statistical Manual of Mental Disorders-IV
Dynorphin, 68
E
Employee assistance programs, 228
Epidemiologic Catchment Area Program, 108, 181
Epidemiology
benefits of, in drug use research, 5, 15, 95-96
community-level assessments, 105
conceptual framework, 94-95
data collection needs, 107
data on natural history of drug use, 108-109
drug use by military personnel, 104-105
drug use by pregnant women, 105, 166
drug use by youths, 99-101
drug use of arrested persons, 103-104
general population surveys, 96-102
HIV/AIDS research opportunities, 164-165
HIV transmission, 8
methodological issues, 111-113
metropolitan area studies, 102-103
opportunities for enhancement, 107-113
prevalence trends, 99
psychiatric comorbidity studies, 101-102, 107-108
research recommendations, 5, 113-114
scope, 94
self-reported data, 112-113
social-cultural factors, 109-111
subpopulation surveys, 102-105
terminology, 95
Ethanol. See Alcohol
Etiology
approach to drug use research, 5-6, 117-118
behavioral models, 36-37
contextual/environmental factors, 124-127
genetic vulnerability, 119-120
medical model, 20-21
physiological vulnerability, 120-121
psychosocial vulnerability, 122-124
recommendations for research, 6, 130-131
research goals, 118
research opportunities, 127-130
sociocultural factors, 109-111, 126-127
See also Motivation for drug use
Excitatory amino acids, 38, 58-59, 82, 86
Extent of drug abuse, 2, 21, 193
among psychiatric-disordered patients, 108, 123-124
demographic variables, 96-99
general population surveys, 96-102
specific population surveys, 102-105
F
Families
high-risk, 150
parental drug abuse, 176
preventive interventions, 143-145, 149-150
protective factors enhancement, 128, 143
Fetal alcohol syndrome, 170
Fetal drug exposure, 8
alcohol, 169-170
cocaine, 171-172
health effects, 167
HIV transmission, 163
life span effects, 174-175
marijuana, 171
multiple drug use, 173
nicotine, 168-169
obstacles to quantifying effects of, 167-168
opiates, 170-171
opportunities for research, 172-175
paternal drug use, 174
prevalence of maternal drug use, 166
recommendations for research, 176
windows of biological vulnerability, 172-173
See also Pregnancy, drug use in
Functional magnetic resonance imaging (fMRI), 72, 81
Funding of research, 1
obstacles to interdisciplinary research, 30
stability of, 24-25
G
Gender differences
drug dependence, 96-99
drug-taking behavior, 96-99
psychiatric comorbidity, 212
treatment implications, 212-213
Genetics
adoption studies, 120
alcohol-related violence, 178
drug-induced adaptations, 75, 76
etiological factors, 119-120
individual differences in drug response, 62-64
knock-out technology, 79
research opportunities, 78-79
transgenic engineering, 79-80
twin studies, 119-120
H
Hallucinogens, 65
violent behavior associated with, 179-180
Harrison Narcotics Act, 253, 254
Health Care Financing
Health maintenance organizations, 223-224, 228-229
Heroin, 105
craving response in users, 46
market characteristics, 260
neurochemical response, 64-65
HIV/AIDS
access to care, 205-206
drug abuse effects on course of, 83
drug abuse treatment and, 202, 204-207
economic costs, 163
in infants and children, 163
injection drug use as risk factor, 8, 22
medical complications, 204-205
needle exchange programs for risk reduction, 165-166, 255
prevention, 165-166
recommendations for research, 8, 166, 215
research opportunities, 164-166
transmission, 161-163
Hypothalamic-pituitary-adrenal axis, 63
I
Illicit drug use
extent in general population, 96-102
extent in specific populations, 102-105
Immunology, drug vaccination, 39-40, 85
Independent practice association, 224
Individual differences
genetic-environmental factors in drug response, 62-64
in response to drugs, 120-121
treatment matching, 207-209
vulnerability to drug use, 48
Initiation of drug use
epidemiological data, 109
injection drugs, 166
personality risk factors, 122-123
Injection drug use
extent of, 164
HIV/AIDS epidemiology, 164-165
HIV transmission, 8, 22, 161-163
initiation, 166
medical complications of HIV, 204-205
needle exchange programs, 165-166, 255
Interdisciplinary research, 15-16, 29-30
International Classification of Diseases, 10, 18-19, 201
Interpersonal psychotherapy, 196
L
associative processes, 65-66
Legal issues
drug use in pregnancy, 213, 269-270
prohibition of drugs as policy approach, 252-253
Life Skills Training, 141-142
Locus coeruleus, 68-69
Lysergic acid diethylamide, 65, 179, 210
M
Magnetic resonance angiography, 81
Magnetic resonance spectroscopy, 72, 81
Managed care
access to drug abuse treatment, 231-235
behavioral health care, 223, 227-228
benefit design, 226-227, 231-236
carve-in/carve-out vendors, 223-225, 226-227, 228-229
characteristic features, 223
cost-effectiveness, 239-241
cost of drug abuse treatment, 231-235
cost-shifting, 243-244
delivery systems, 223-225
effectiveness, 237-239
enrollment, 223
financing structure, 225-226
management, 225
medical cost offsets, 242-243
obstacles to research, 244-246
outcomes and effectiveness, 222-223, 236-237
public vs. private systems, 228-231
quality of care, 241-242
recommendations for research, 10, 231, 236, 246
selective contracting, 225
utilization of drug abuse treatment, 231-235
Marijuana
extent of dependence, 102
maternal use during pregnancy, 166, 171
neurochemical response, 65, 67
predisposing personality traits, 123
regulatory policy, 252, 254-255
trends, 100-101
user perceptions, 109-110
violent behavior associated with, 179
Medicare, 229
Methadone maintenance, 26, 71, 194, 195
effectiveness, 197
gender differences, 212-213
on-site medical services, 206-207
regulatory policy, 253-254
research needs, 202
N-Methyl-D-aspartate antagonists, 75
Methylenedioxymethamphetamine, 83
Midwestern Prevention Project, 141-142
Monitoring the Future Study, 99-101
Monoamine oxidase, 121
Monoclonal antibodies, 40
Motivation for drug use
adjunctive behaviors, 43-44
alternative reinforcers, 44-45
appetitive behaviors, 45
deterrent effects of criminal sanctions, 261-266
neurochemical systems in withdrawal, 66-67
priming dose phenomenon, 45
treatment matching criterion, 208-209
Motivational enhancement therapy, 196
N
Nalmafene, 195
National AIDS Demonstration Research Project, 106
National Comorbidity Survey, 101-102
National Cooperative Agreement for AIDS Community Based Outreach Intervention Research Program, 106-107
National Health and Nutrition Examination Survey, 106
National Health Interview Survey of Drug and Alcohol Use, 106
National Household Survey on Drug Abuse, 96-99
National Institute of Justice, 11, 271
National Institute of Mental Health (NIMH), 14
National Institute on Alcohol Abuse and Alcoholism (NIAAA), 10, 14 , 231
National Institute on Drug Abuse (NIDA), 13-14, 31, 74
recommendations for, 10, 11, 231, 271
National Institutes of Health (NIH), 30
National Longitudinal Survey of Youth, 106
Needle exchange programs, 165-166, 255
Neuroscience research
accomplishments, 4-5, 15-16, 56-57, 62
brain disease model of addiction, 20-21
individual differences in drug response, 62-64
opportunities for enhancement, 78-86
for pharmacotherapies, 16, 203
research needs, 75-78
Neurotransmitter mechanics, 15-16, 58
alcohol-violence linkage, 178
animal models, 80-81
biomarkers for substance abuse, 121
dopaminergic system, 37-38, 62, 64-65, 67, 70, 71, 73, 76-77, 79, 82-83, 172
drug agonists, 71
drug antagonists, 70-71
in drug dependence, 61-62
drug-induced adaptations, 75-76
in drug tolerance, 65-66
life span effects of drug exposure, 174-175
long-term effects of drug use, 60, 76-77, 84-85
medial forebrain bundle in, 64
neurotoxic effects of drug use, 83-84
neurotrophic factors, 60-61
nucleus accumbens in, 77
pain pathways, 74-75
pain research, 85-86
prenatal cocaine exposure, 172
protein phosphorylation, 59-60
psychiatric disorder-drug dependence linkages, 82-83
receptor activity, 58-59
in reinforcement process, 64-65, 67
second messenger systems, 59-60
signal transduction pathways, 80
synaptic transmission, 57-58
in withdrawal, 66-69
See also Neuroscience research
Neurotrophins, 60-61
Nicotine/tobacco, 127
agonist therapies, 71
craving response in users, 46
economic costs of maternal use during pregnancy, 167
extent of dependence, 102
neurochemical reinforcement, 65
prenatal exposure, 168-169
prevalence of maternal use during pregnancy, 166
regulatory policy, 253
withdrawal, 42-43
youth-oriented antismoking campaigns, 145-146
Nitric acid, 59
Norepinephrine, 66
O
Office of Justice Programs, 14
Opiates/opioids
addiction treatment options, 194
agonists/antagonists, 40, 70, 195
brain imaging studies, 86
clinical use, 86
definitions, 18
drug interactions, 173
drug-seeking behaviors in withdrawal, 66-67
locus coeruleus model of dependence, 68-69
neurochemical response, 61, 64-65, 67, 68
pain-relieving action, 74-75
pharmacotherapy, 195-196
prenatal exposure, 170-171
receptor sites, 86
violence linkage, 178
Opioid peptide system, 62, 65, 66, 67, 68
Outcome research
assessment instruments, 201-202, 239
coerced treatment, 267-268
community-based preventive interventions, 146-147, 151
craving as treatment outcome indicator, 46-47
day hospital vs. inpatient treatment, 240-241
drug abuse treatment in corrections system, 214
drug use morbidity/mortality, 106
gender differences, 212-213
managed drug abuse care, 10, 222-223, 236-244
placement criteria as outcome predictor, 242
research needs, 202
treatment efficacy, 197-198
violent behavior in psychiatric drug abuse patients, 180
Oxazepam, 211
P
Pain
brain imaging studies, 86
clinical indications for opioids, 86
neurobiological research, 4-5, 85-86
neurochemistry, 74-75
significance of drug abuse research, 16, 74-75
Parent-focused preventive interventions, 143-144
PCP. See Phencyclidine
Peer relations, 125-126
Personality disorders, 82, 180
Pharmacotherapy
antagonists of drugs of abuse, 40, 70-71
antidepressant, 210
drug interactions, 211
implementation of research findings, 28
implications of medical model of dependence, 26-27
integrated with psychosocial treatment, 194
low abuse-potential medications, 38-39
medications development, 203-204
with pregnant women, 213
for psychiatric disorders in drug abusers, 210-211
research accomplishments, 16
Phencyclidine (PCP), 38, 82, 179
Phosphatidylinositol, 59
Positron emission tomography, 72-73
Pregnancy, drug use in
confidentiality issues in treatment, 269-270
costs of, 167
criminalization of, 213, 269-270
fetal alcohol exposure, 169-170
fetal cocaine exposure, 171-172
fetal marijuana exposure, 171
fetal nicotine exposure, 168-169
fetal opiate exposure, 170-171
obstacles to quantifying fetal drug exposure effects, 167-168
opportunities for research on fetal exposure, 172-175
paternal drug use, 174
pharmacotherapy for, 213
recommendations for research, 176
self-reported data, 173-174
treatment implications, 213
windows of fetal vulnerability, 172-173
Preventive interventions
administration of, 153-154
conceptual trends, 139-140
cost-benefit analysis, 149
criminal sanctions, 261-266
evaluation methodology, 143, 153
family-based, 143-145, 149-150
HIV/AIDS, 165-166
for minority populations, 148, 152-153
protective factors enhancement, 127-128
in public health framework, 25
recommendations for, 7
recommendations for research, 154
research accomplishments, 15
research needs, 147-151
research opportunities, 152-153
research trends, 6
school-based, 141-143, 147-149, 152
targeted to transition from abuse to dependence, 148, 152
Priming dose phenomenon, 45
Product development, 28
antiaddiction medications, 203-204
behavioral models in new drug development, 38-41
Protective factors
for alcoholism, 121
familial, 143
protective-protective, 118
research opportunities, 127-128
risk-protective, 118
Psychedelic drugs. See Hallucinogens
Psychiatric disorders
benefits of drug abuse research, 16
drug dependence-associated, 82-83, 124
drug-induced, 210
gender differences, 212
psychotic disorders, 82
as risk factor for drug abuse, 123
Psychiatric disorders with co-occurring drug abuse, 101-102, 107-108, 123-124
assessment and diagnosis, 210
in parents, 175
pharmacotherapy, 210-211
research recommendations, 182
violent behavior associated with, 180-182
Psychotherapy, 196-197
Public perceptions of addiction, 20-21
drug research funding and, 25
on effects of drug-taking, 109-110
political context of research, 28
Q
Quality of care, in managed drug abuse care, 241-242
R
physiological differences in drug response, 99, 110, 120-121
preventive intervention design, 148, 152-153
youth drug use, 128
Reinforcement
contingency contracting therapy, 196-197
individual differences, 63
via antagonists of drugs of abuse, 70-71
Relapse
after prolonged abstinence, 84-85
animal models, 69
behavioral research in prevention, 42
drug antagonist therapies, 70-71
in medical model of addiction, 20
naltrexone effects, 195
neurobiological substrate, 69, 84-85
priming dose phenomenon, 45
probability, 19-20
Research in drug use
achievements of, 14-16
cross-disciplinary benefits, 15-16, 29-30
historical development, 13, 284-292
implementation of findings, 27-28
implications of medical model of dependence, 26-27
obstacles to interdisciplinary collaboration, 29-30
opportunities for enhancing, 22-24
as percentage of federal spending on drug control, 15-16
political context, 28
professional development, 28-29
in public health framework, 25-26
Risk factors
behavioral research on, 48-49
familial, 124-125, 129, 143-144
genetic, 119120
peer, 125-126
personality traits, 122-123
psychopathology, 123-124
research opportunities, 128-130
sociocultural, 126-127
violent behavior, in psychiatric drug abusers, 181
S
School-based prevention programs, 141-143, 147-149, 152
Self-reported data, 112-113
maternal drug use, 173-174
Sexuality/sexual behavior
drug effects on male reproductive system, 174
HIV transmission, 162-163
Single-photon emission computed tomography, 72
Social norms, 109-110
risk factors, 126-127
Stages of drug-taking behavior, 3, 18
epidemiologic data, 108-109
targeting of preventive interventions, 7, 139
treatment matching criteria, 208-209
Stress, drug-taking response to, 63
Substance Abuse and Mental Health Services Administration, 10, 14, 106, 231
Supportive-expressive psychotherapy, 196
Survey of Health Related Behaviors Among Military Personnel, 104-105
T
Technology transfer, 27-28
Tetrahydrocannabinol (THC). See Marijuana
Tobacco. See Nicotine/tobacco
Tolerance
clinical features, 19
in etiology of alcoholism, 121
neural substrate, 65-66
Treatment
access, 193, 205-206, 212, 213, 231-235
assessment and diagnosis, 200-202
behavioral conditioning, 41-42
chemical dependency programs, 194
for children and adolescents, 214-215, 270
for co-occurring psychiatric disorders in drug abusers, 9, 209-211
confidentiality issues, 268-270
in correctional settings, 213-214
cost-benefit analysis, 198-200
cost-shifting, 243-244
costs of managed drug abuse care, 167
of drug-abusing women, 212-213
drug users with HIV, 204-207
effectiveness of managed care, 237-239
HIV risk reduction in, 165
indications for, 192-193
integrated psychosocial-pharmacologic, 194
legally coerced, 266-268
in managed care systems, 10, 222, 225, 227-228, 231-236
medical cost offsets, 242-243
modalities, 9
options, 194
outpatient, 194
patient compliance, 198
placement criteria, 242
of pregnant women, 213, 269-270
primary medical care in drug abuse programs, 205-207
psychosocial, 196-197
public vs. private settings, 228-231
recommendations for research, 9-10, 215
research accomplishments, 15, 192, 193
research opportunities, 202
significance of craving, 46-47
significance of motivational
research, 43-45
special populations, 211-212
in therapeutic communities, 194
treatment matching, 207-209
utilization, 193
vs. drug control strategies, 199-200
vs. punishment, 256-257
See also Pharmacotherapy
Treatment Alternatives to Street
Treatment Outcome Prospective Study, 197-198
Treatment Services Review, 202
Twelve-step programs, 194
U
Urinalysis, 113
Utilization of treatment resources, 193
confidentiality and, 268-270
managed care systems, 231-235
medical cost offsets, 242-243
V
Violence/violent behavior
alcohol linkages, 177-178
behavioral research, 47-48
cocaine linkages, 178-179
co-occurring psychiatric disorders and drug abuse, 180-182
drug abuse linkages, 176
in drug-related crimes, 176-177, 178
in drug trade, 176
drug use linkages, 8-9
opiate linkages, 178
as pharmacological effect of drugs, 177-180
as predictor of alcoholism, 122
research recommendations, 9, 182
Vulnerability to drug use, 48-49
Genetic basis, 75, 78, 119-120
Individual differences, 120-121
W
behavioral research, 42-43
conditioned, 42
determinants of drug-seeking
behavior in, 66-67
drug antagonist therapies, 70-71
hypothalamic system in, 67
locus coeruleus model, 68-69
negative affective states in, 67
neurochemical substrate, 66-69
in newborns, 170
physical signs, 66-67
psychological signs, 66
Y
Youth Risk Behavior Surveillance System, 106