Drugs, Behavior, and Modern society

Eighth Edition

Drugs, Behavior, and Modern Society

Charles F. Levinthal

Hofstra University

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Library of Congress Cataloging-in-Publication Data

Levinthal, Charles F. Drugs, behavior, and modern society / Charles F. Levinthal, Hofstra University. -- Eighth edition. pages cm Includes index. ISBN-13: 978-0-205-95933-4 ISBN-10: 0-205-95933-4 1.Drugs. 2.Drug abuse. 3.Drugs--Physiological effect. 4.Psychotropic drugs. 5.Psychopharmacology. I.Title. HV5801.L49 2014 362.29--dc23

2013013402

10987654321

ISBN-10: 0-205-95933-4 ISBN-13: 978-0-205-95933-4

For my grandsons

Aaron Matthew Levinthal and

Michael Samuel Levinthal

brief Contents

Part One

Chapter 1 Chapter 2 Chapter 3

Drugs in Society/Drugs in Our Lives 1

Drugs and Behavior Today 1 Drug-Taking Behavior: Personal and Social Issues28 How Drugs Work in the Body and on the Mind60

Part two

Chapter 4 Chapter 5 Chapter 6 Chapter 7

Legally Restricted Drugs in Our Society 89

The Major Stimulants: Cocaine and Amphetamines89 Opioids: Opium, Heroin, and Opioid Pain Medications118 LSD and Other Hallucinogens143 Marijuana167

Part three Legal Drugs in Our Society 191

Chapter 8 Chapter 9 Chapter 10 Chapter 11

Alcohol: Social Beverage/Social Drug191 Chronic Alcohol Abuse and Alcoholism220 Nicotine and Tobacco Use248 Caffeine275

Part four Enhancers and Depressants 293

Chapter 12 Chapter 13

Performance-Enhancing Drugs and Drug Testing in Sports293 Depressants and Inhalants315

Part five Medicinal Drugs 339

Chapter 14 Prescription Drugs, Over-the-Counter Drugs, and Dietary Supplements339

Chapter 15 Drugs for Treating Schizophrenia and Mood Disorders362

Part six

Chapter 16 Chapter 17

Prevention and Treatment 379

Substance-Abuse Prevention379 Substance-Abuse Treatment: Strategies for Change407

iv Brief Contents

Contents

Preface xvi

Part OneDrugs in Society/ Drugs in Our Lives 1

Chapter 1

Drugs and Behavior Today1

By the Numbers . . .2 Social Messages About Drug Use3 Two Ways of Looking at Drugs and Behavior4

A Matter of Definition: What Is a Drug?5

He a l t h L i n e : Defining Drugs: Olive Oil, Curry Powder, and a Little Grapefruit?6 Instrumental Drug Use/Recreational Drug Use6 Drug Misuse or Drug Abuse?7

D r u g s . . . i n F o c u s : Drug Abuse and the College Student: An Assessment Tool8

Drugs in Early Times9 Drugs in the Nineteenth Century10 Drugs and Behavior in the Twentieth Century11

Drugs and Behavior from 1945 to 196012 Drugs and Behavior after 196012

Q u i c k C o n cep t C h ec k 1 . 1 :

Understanding the History of Drugs and Behavior13 Present-Day Attitudes toward Drugs14 Patterns of Drug Use in the United States14 Illicit Drug Use among High School Seniors15 Illicit Drug Use among Eighth Graders and Tenth

Graders16 Illicit Drug Use among College Students16 Alcohol Use among High School and College Students16 Tobacco Use among High School and College Students17 Drug Use and Drug Perceptions17 Illicit Drug Use among Adults Aged Twenty-Six and

Older18 Making the Decision to Use Drugs19

Q u i c k C o n cep t C h ec k 1 . 2 :

Understanding Present-Day Drug Use in the United States19

Specific Risk Factors19 Specific Protective Factors21

Present-day Concerns21 Club Drugs21 Nonmedical Use of Prescription Pain Relievers21

D r u g s . . . i n F o c u s : Facts about Club Drugs22 Nonmedical Use of Prescription Stimulant Medications23 Nonmedical Use of Over-the-Counter Cough-and-Cold Medications23 Why Drugs?23

P o r t r a i t : From Oxy to Heroin-- The Life and Death of Erik24

Summary24/Key Terms25/Endnotes26

ChapTer 2

Drug-Taking Behavior: Personal and Social Issues28

By the Numbers . . .29 Drug Toxicity30

D r u g s . . . i n F o c u s : Acute Toxicity in the News: Drug-Related Deaths32

Q u i c k C o n cep t C h ec k 2 . 1 :

Understanding Dose-Response Curves33 The DAWN Reports33

Emergencies Related to Illicit Drugs34 Drug-Related Deaths34 Judging Drug Toxicity from Drug-Related Deaths35 Demographics and Trends35 From Acute Toxicity to Chronic Toxicity36 Behavioral Tolerance and Drug Overdose37

Q u i c k C o n cep t C h ec k 2 . 2 :

Understanding Behavioral Tolerance through Conditioning38 Physical and Psychological Dependence39 Physical Dependence39 Psychological Dependence39 Diagnosing Drug-Related Problems: The Health Professional's Perspective41

Contents v

Special Circumstances in Drug Abuse43 Drug Abuse in Pregnancy43 Drug Abuse and HIV Infection43

He a l t h L i n e : Effects of Psychoactive Drugs on Pregnant Women and Newborns44

Drugs, Violence, and Crime45 Pharmacological Violence45 Economically Compulsive Violence46 Systemic Violence47

Governmental Policy, Regulation, and Laws48 Efforts to Regulate Drugs, 1900?197048 Rethinking the Approach toward Drug Regulation, 1970?Present49

Drug Law Enforcement and Global Politics50

P o r t r a i t : Pablo Escobar--Formerly Known as the Colombian King of Cocaine51

He a l t h L i n e : Harm Reduction as a National Drug-Abuse Policy53

Summary54/Key Terms55/Endnotes55

P o i n t / C o u n t e r p o i n t I : Should We Legalize Drugs in General?58

Chapter 3

How Drugs Work in the Body and on the Mind60

By the Numbers . . .61 How Drugs Enter the Body61

Oral Administration61 Injection62 Inhalation63 Absorption through the Skin or Membranes63 How Drugs Exit the Body64

D r u g s . . . i n F o c u s : Ways to Take Drugs: Routes of Administration65

Factors Determining the Behavioral Impact of Drugs66 Timing66 Drug Interactions67 Cross-Tolerance and Cross-Dependence67

Q u i c k C o n cep t C h ec k 3 . 1 :

Understanding Drug Interactions67

He a l t h Ale r t : Adverse Effects of Drug? Drug and Food?Drug Combinations68 Individual Differences69

Introducing the Nervous System69 The Peripheral Nervous System70 Sympathetic and Parasympathetic Responses70 The Central Nervous System71

Understanding the Brain72 The Hindbrain73 The Midbrain73 The Forebrain73

Q u i c k C o n cep t C h ec k 3 . 2 :

Understanding Drugs and Brain Functioning74 Understanding the Neurochemistry of Psychoactive

Drugs74 Introducing Neurons74 Neuronal Communication75 Drug Influences on Neuronal Communication76 The Major Neurotransmitters in Brief:

The Big Seven76 Physiological Aspects of Drug-Taking Behavior78

The Blood?Brain Barrier78

D r u g s . . . i n F o c u s : Endorphins, Endocannabinoids, and the "Runner's High"79 Biochemical Processes Underlying Drug Tolerance80

Q u i c k C o n cep t C h ec k 3 . 3 :

Understanding Cross-Tolerance and Cross-Dependence80 Physiological Factors in Psychological Dependence81

He a l t h L i n e : Drug Craving and the Insula of the Brain82

Psychological Factors in Drug-Taking Behavior82 Expectation Effects83

P o r t r a i t : Nora D. Volkow--A ScientistGeneral in the War on Drugs84 Drug Research Procedures85

Summary85/Key Terms86/Endnotes86

Part TWO Legally Restricted Drugs in Our Society 89

Chapter 4

The Major Stimulants: Cocaine and Amphetamines89

By the Numbers . . .90 The History of Cocaine90

Cocaine in Nineteenth-Century Life91

vi Contents

 He a l t h Ale r t : Cocaine after Alcohol: The Risk of Cocaethylene Toxicity91 Freud and Cocaine92

D r u g s . . . i n F o c u s : What Happened to the Coca in Coca-Cola?93

Q u i c k C o n cep t C h ec k 4 . 1 :

Understanding the History of Cocaine94 Acute Effects of Cocaine94 Chronic Effects of Cocaine95

He a l t h Ale r t : The Physical Signs of Possible Cocaine Abuse95

Medical Uses of Cocaine96 How Cocaine Works in the Brain96 Present-Day Cocaine Abuse96

From Coca to Cocaine97 From Cocaine to Crack97

D r u g s . . . i n F o c u s : Crack Babies Revisited: What Are the Effects?99

Patterns of Cocaine Abuse100 Treatment Programs for Cocaine Abuse100

D r u g s . . . i n F o c u s : Paco: A Cheap Form of Cocaine Floods Argentine Slums and Beyond100

P o r t r a i t : Robert Downey Jr. and Others--Cleaning Up after Cocaine101

Amphetamines103 The Different Forms of Amphetamines103 The History of Amphetamines104 How Amphetamines Work in the Brain104

Acute Effects of Amphetamines104 Chronic Effects of Amphetamines105

Methamphetamine Abuse105 Present-Day Patterns of Methamphetamine Abuse105

D r u g s . . . i n F o c u s : Methamphetamine and the Heartland of America107 Methamphetamine-Abuse Treatment107

Q u i c k C o n cep t C h ec k 4 . 2 : Understanding Patterns of Cocaine and Methamphetamine Abuse108

Medical Uses for Amphetamines and Similar Stimulant Drugs108

He a l t h L i n e : "Bath Salts" as a New Form of Stimulant Abuse109 Stimulant Medications for ADHD109 Other Medical Applications110

Stimulant Medication and Cognitive Enhancement111

Summary111/Key Terms112/Endnotes112

P o i n t / C o u n t e r p o i n t II : Should Cognitive Performance-Enhancing Drugs Be Used by Healthy People?116

Chapter 5

Opioids: Opium, Heroin, and Opioid Pain Medications118

By the Numbers . . .119 Opium in History119 The Opium War121 Opium in Britain and the United States122 Morphine and the Advent of Heroin123 Opioids in American Society124 Opioid Use and Heroin Abuse after 1914124 Heroin Abuse in the 1960s and 1970s125 Heroin and Other Opioids since the 1980s126

Q u i c k C o n cep t C h ec k 5 . 1 :

Understanding the History of Opium and Opioids127 Effects on the Mind and the Body127 How Opioids Work in the Brain128 Patterns of Heroin Abuse129 Tolerance and Withdrawal Symptoms130 The Lethality of Heroin Abuse130

Q u i c k C o n cep t C h ec k 5 . 2 :

Understanding the Effects of Administering and Withdrawing Heroin131 Heroin Abuse and Society132 Treatment for Heroin Abuse132 Heroin Detoxification132 Methadone Maintenance133 Alternative Maintenance Programs134 Behavioral and Social-Community

Programs134 Medical Uses of Opioid Drugs134

He a l t h Ale r t : Sustained-Release Buprenorphine: A New Era in Heroin-Abuse Treatment135 Beneficial Effects135

Prescription Pain Medication Misuse and Abuse137 OxyContin Abuse 137 Responses to OxyContin Abuse137

Contents vii

 P o r t r a i t : David Laffer--Pharmacy Robber and Killer of Four138 Abuse of Other Opioids Pain Medications138 Prevalence of Nonmedical Use of Opioid Pain Medications138

Summary139/Key Terms140/Endnotes140

Chapter 6

LSD and Other Hallucinogens143

By the Numbers . . .144 A Matter of Definition144 Classifying Hallucinogens145 Lysergic Acid Diethylamide (LSD)146

D r u g s . . . i n F o c u s : Strange Days in Salem: Witchcraft or Hallucinogens?147 The Beginning of the Psychedelic Era147

P o r t r a i t : Timothy Leary--Nutty Professor or Psychedelic Visionary?149 Acute Effects of LSD149 Effects of LSD on the Brain150 Patterns of LSD Use151

Facts and Fiction about LSD151 Will LSD Produce Substance Dependence?151 Will LSD Produce a Panic Attack or Psychotic Behavior?151 Will LSD Increase Your Creativity?152 Will LSD Damage Your Chromosomes?152

He a l t h Ale r t : Emergency Guidelines for a Bad Trip on LSD152 Will LSD Have Residual (Flashback) Effects?153 Will LSD Increase Criminal or Violent Behavior?153

Psilocybin and Other Hallucinogens Related to Serotonin154 Lysergic Acid Amide (LAA)154

He a l t h L i n e : Bufotenine and the Bufo Toad155 Dimethyltryptamine (DMT)155 Harmine156

Hallucinogens Related to Norepinephrine156 Mescaline156 DOM156

D r u g s . . . i n F o c u s : Present-Day Peyotism and the Native American Church157 MDMA (Ecstasy)157

He a l t h Ale r t : MDMA Toxicity: The Other Side of Ecstasy158

Hallucinogens Related to Acetylcholine159 Amanita muscaria159 The Hexing Drugs and Witchcraft159

Miscellaneous Hallucinogens160 Phencyclidine (PCP)161 Acute Effects of PCP161

Q u i c k C o n cep t C h ec k 6 . 1 :

Understanding the Diversity of Hallucinogens161

Patterns of PCP Abuse162 Ketamine162

Q u i c k C o n cep t C h ec k 6 . 2 :

Understanding PCP163 Salvia divinorum163 Summary163/Key Terms165/Endnotes165

Chapter 7

Marijuana167

By the Numbers . . .168 A Matter of Terminology168 The History of Marijuana and Hashish170

Hashish in the Nineteenth Century170 Marijuana and Hashish in the Twentieth Century170 The Anti-Marijuana Crusade171 Challenging Old Ideas about Marijuana172 Acute Effects of Marijuana172 Acute Physiological Effects173 Acute Psychological and Behavioral Effects173

Q u i c k C o n cep t C h ec k 7 . 1 :

Understanding the Effects of Marijuana174

D r u g s . . . i n F o c u s : The Neurochemical "Yin and Yang" of Cannabis175

Effects of Marijuana on the Brain175 Chronic Effects of Marijuana176

Tolerance176 Withdrawal and Dependence176 Cardiovascular Effects177 Respiratory Effects and the Risk of Cancer177 Effects on the Immune System178 Effects on Sexual Functioning and Reproduction178 Long-Term Cognitive Effects and the Amotivational

Syndrome178

viii Contents

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