How to withdraw from cocaine

Drug Addiction Report

Drug Addiction Report

You're going to discover so many things on addiction with little effort Not only will you discover the thrill of breaking free from your addiction, but you'll also learn extra bonus tips to actually help other people This new breakthrough book is a guide, really. A guide as a result of years of searching, studying, and scouring hundreds of websites, stores, and magazines.

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Withdrawal from Harmful Drugs at Home

How to safely detox at home especially from drugs like methadone, benzodiazepines, alcohol, suboxone, oxycontin, cocaine, crack, heroin, crystal meth, pain killers. How to prepare your body before withdrawal and dramatically lower withdrawal symptoms. The dangers of withdrawing from methadone, benzodiazepines, alcohol, crack, cocaine and opiates, and how to avoid them. What to expect when going through withdrawal. (mentioned throughout the video) How to make withdrawal easier and safer. The best way to overcome sleeplessness when withdrawing. How to alleviate depression when withdrawing. What factors could cause you to have more severe withdrawal symptoms and what step to take to address them before attempting withdrawal. Whether you can die from methadone withdrawal. The difference between withdraw, detox and rehab. What to look for when comparing detox centers.

Withdrawal from Harmful Drugs at Home Overview

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Development Of Cocaine Anesthesia

Cocaine came into general use in 1884, not only for application to mucous membranes but also for subcutaneous injections, and because of its suitability for blocking nerves, it found use in regional anesthesia. New methods for cocaine administration were soon added to those mentioned. Thus, in 1885, Corning published a paper in which he described experiments he had conducted on dogs, injecting 1.18 mL of a 2 solution of cocaine hydrochloride into the space situated between the spinous processes of two inferior dorsal vertebrae, with the result that the animal did not react for several hours, even if a stimulus was applied from a powerful faradic battery or if the hind limbs were pinched or pricked ( Fig. 1-6 ).164 One human experiment produced a similar local effect, and the author concluded Whether the method will ever find an application as a substitute for etherization in genitourinary or other branches of surgery, further experiments alone can show. Corning came back to the...

Stimulant Intoxication Cocaine and Amphetamines

The desired outcomes of stimulant intoxication are appropriate management of medical and psychiatric problems. Medical problems include hyperthermia, hypertension, cardiac arrhythmias, stroke, and seizures. Some medical problems are related to route of administration such as nosebleeds with intranasal administration and infections with IV administration. Psychiatric effects include anxiety, irritability and aggression, and psychosis. Psychosis may take the form of tactile hallucinations (such as the sensation of bugs crawling under one's skin, i.e., formication), visual hallucinations (usually simple geometric shapes), and most commonly, auditory hallucinations, as well as delusions of paranoia or grandeur. Cocaine is short acting, and a single dose of a benzodiazepine sedative-hypnotic may be sufficient treatment for anxiety reactions. Depending on the half-life of the benzodiazepine, one or more sequential doses may be required for amphetamine intoxication. Because stimulants are...

Qualitative Identification of Cocaine

In terms of gross morphology, characteristically, coca leaf has two lines which run parallel to the mid-rib on the underside of the leaf. Taxonomically, however, it is difficult to identify leaf and plant material to species on the basis of morphology (leaf and flower structure) alone and indeed hybridization between species is common 5 . In order to establish that the material comes from the genus Erythroxylon and contains controlled substances, it is therefore necessary to demonstrate the presence of cocaine. In bulk (those which can be seen by the naked eye) samples, this is achieved through a good physical description of the materials and packaging, followed by a combination of presumptive tests, TLC and a tandem technique, usually GC-MS.

Quantification of Cocaine

While there are several methods available for the HPLC analysis of cocaine 7 , these appear to have been principally used in toxicological studies. For street drug analysis, the preferred method is currently GC (either GC-FID or GC-MS). In addition to identification, GC-MS can also be used to quantify cocaine in street samples. For simple mixtures which contain only cocaine and a sugar, UV spectroscopy can also be employed for quantification purposes. Examples of each of these approaches are detailed below.

Quantification of Cocaine by UV Spectroscopy

This technique works particularly well if the cocaine is mixed with sugars, from which it can be easily separated by dissolution. Calibration standards are prepared, in methanol solution, at concentrations of 1.0, 0.5, 0.25, 0.125, 0.0625, 0.031 25 and 0.0156 mgml-1, using serial dilutions. A UV spectrum of a holmium filter is first measured to confirm that the instrumental set-up is performing satisfactorily. 0.50 1.00 1.50 2.00 2.50 3.00 3.50 Cocaine (mg ml-1) 0.50 1.00 1.50 2.00 2.50 3.00 3.50 Cocaine (mg ml-1) Figure 6.3 Calibration curve used for the determination of cocaine in a sample by GC-MS. A baseline spectrum for the cuvette in which the cocaine is to be measured is then obtained by using methanol alone. Following this, at each cocaine concentration, ultraviolet spectra between 210 nm and 350 nm, measuring the absorbance values at Amax, are recorded. Between each measurement, the cuvette is washed clean with 'HPLC-grade' methanol and dried. Using the absorbance values...

Comparison of Cocaine Samples

The profiling and comparison of cocaine is a complex process, the details of which are beyond the scope of this present book. However, it is useful to consider the compounds which might be present in a sample and how they arise. These include the cocaine content itself, both from the drug and the ecgonines, and other by-products from the process of cocaine synthesis, along with various breakdown products. In addition, there is nor-cocaine, the N-demethylated product which arises as a consequence of the use of potassium permanganate to purify the cocaine during the synthetic process, plus the cinnamoyl cocaines and the truxillines, which are congeners of cocaine in the original plant products and which are carried through the synthetic processes used in the manufacture of cocaine. One of the best descriptions of cocaine profiling has been presented by Moore et al. 8 . However, such a complete analysis as described in this work is unlikely to find routine use because of its complex and...

The National Directory of Drug Abuse and Alcoholism Treatment and Prevention Programs DHHS Pub No SMA 013243

This publication, offered free by calling the National clearinghouse for Alcohol and Other Drug Information at (800) 729-6686, lists federal, state, local, and private providers of alcoholism and drug abuse treatment and prevention services. It gives the location and selected characteristics of substance abuse service providers and offers information about state authorities and prevention contacts. Each facility is identified by name, with address, telephone number, hotline (if applicable), and codes for types of service providers, facility location, and third-party payments.

Methylenedioxymethamphetamine

Methylenedioxymethamphetamine (MDMA Ecstasy) is a derivative of methamphetamine. It is reported to cause severe damage to the serotonergic neurons in nonhuman primates and decreases in the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid of humans who have abused the drug. y MDMA acts as a stimulant and a hallucinogen. It is abused by individuals who wish to intensify their emotional and sensory experiences. MDMA and a close congener, methylenedioxyamphetamine (MDA), are reported to cause changes in the strength of the emotions. Psychiatrists have experimented with these drugs to facilitate psychotherapy, especially in patients who have difficulty in expressing their emotions.

The Occurrence And Frequency Of Drug Dependence

In common with most mental disorders, drug dependence takes its toll during life and leaves very little trace after death. For this reason, mortality rates based on deaths attributed to drug dependence are an unstable foundation for epidemio-logic inferences, and with no more than a few exceptions epidemiologists generally have turned to the field survey method in order to study the occurrence (incidence) and frequency (prevalence) of this condition in human populations. In the context of this general endorsement of epidemiological field survey methods, some readers may be interested in whether occurrence of drug dependence can be measured surveillance of the routine administrative statistics of hospital or managed care organizations. Any evaluation of this type of surveillance brings an epidemiologist face to face with some of the traditional concerns of psychiatric epidemiology, such as the influence of ''nosocomial'' and ''threshold'' effects (e.g., see Anthony and Van Etten,...

The Occurrence Incidence of Drug Dependence

Incidence values are rates that deserve special attention because they help to convey the probability of becoming a case of drug dependence for the first time, among members of a defined population. An incidence estimate is one way to express the risk of developing drug dependence during some span of time. By comparing incidence or risk estimates for different subgroups of a population, it is possible to discriminate conditions of heightened risk and suspected determinants of risk, as distinct from prevalence correlates that do not determine risk of drug dependence (e.g., see Anthony et al., 1994). It is important to recognize that drug taking can be conceptualized and measured in relation to an underlying dimension that runs from no drug use upward through increasing levels of drug involvement, as discussed in relation to the pathogenesis of drug dependence. Many strengths and benefits accrue by studying drug taking in this fashion (e.g., see Pandina et al., 1981 Brook et al.,...

The Frequency Prevalence of Drug Dependence

In contrast with incidence, prevalence values are proportions that communicate the probability of being affected by drug dependence within a defined population. Among persons who have survived to some specific time, the lifetime prevalence expresses the probability of being a currently active or a former case of drug dependence. That is, among these survivors, lifetime prevalence is the probability of having become a case during the span of life prior to assessment (Kramer et al., 1980). When studying drug dependence, it is especially important to link the concept of survivorship with the concept of lifetime prevalence. To the extent that drug dependence accounts for excess mortality, a lifetime prevalence value can understate the cumulative probability of developing drug dependence. Furthermore, lifetime prevalence comparisons can give a distorted view of high-risk groups. That is, if two groups have equal risk of developing drug dependence, but different risks...

Suspected Determinants Of Drug Dependence Prevalence

An important goal for epidemiologic research on drug dependence, beyond quantifying occurrence and frequency, is to identify the determinants of drug dependence in human populations and to translate these research findings into practical strategies for public health work and preventive psychiatry. As discussed in the prior section of this chapter, prevalence is influenced not only by the conditions and processes out of which drug dependence develops but also by forces that extend or shorten the duration of drug dependence, including mortality rates. In this context, mortality rates are important for two reasons. First, excess mortality associated with drug dependence will reduce the duration of drug dependence and the survivorship of cases, with a resulting downward impact on prevalence values. Second, mortality rates together with birth rates can affect the broad age structure of human populations, and certain changes in age structure can yield either dramatic increases or dramatic...

Race as a Determinant of Risk for Drug Dependence

One of the most common preconceptions about race and drug dependence, sometimes appearing in the drug-dependence literature, is that there is something about African-Americans to make them more vulnerable. This preconception is buttressed by studies of public treatment for drug dependence and by criminal justice research, which show disproportionate representation of African-Americans among drug-dependent patients and among persons arrested and convicted for drug-related crimes (e.g., see Kandel, 1991). Science ethics, by itself, dictates that no epidemiologist should make superficial or casual statements about race and drug dependence, given the long tradition of research tinged with racism or used to bolster white supremacist or racist arguments. More than most observers, epidemiologists are well equipped to understand that race is strongly confounded with social disadvantage in the Western world, where most drug dependence studies have been conducted, and elsewhere. More than most...

Other Suspected Determinants of Drug Dependence

The moderate-to-strong associations between sex, age, and drug dependence pose a challenge in epidemiologic research on other suspected determinants of drug dependence, which also might be related to sex and age. To protect against confounding by these factors, investigators interested in drug dependence can turn to epidemiologic strategies such as matching, stratification, or statistical modeling. More often, however, they have restricted the sex or age composition of their study samples. For example, there are more epidemiologic studies of drug dependence among males than among females, and there is essentially no strong evidence on causes of drug dependence syndromes that occur past age 40. Study of individual cases shows that syndromes of drug dependence do occur in the middle and later years of adulthood however, after ages 45-55 years, the risk of developing these syndromes for the first time in ones life is quite small (e.g., see Eaton et al., 1989). Heredity and Genetics...

Cocaine and Crack Cocaine

Cocaine is a concentrated form of coca leaves which is usually snorted and absorbed quickly. It creates a very intense high. Eventually cocaine addiction can lead to severe problems in the nasal cavity, along with paranoia and insomnia. Sigmund Freud wrote a paper called Uber Cola in which he experimented on himself a dozen times and noted the 'exhilaration and lasting euphoria.' He later changed his mind about benefits when a friend died from an overdose. Other prominent creative individuals who used cocaine include Elton John, Stevie Nicks, and Isadora Duncan. Dr Jekyl and Mr Hyde is thought to be at least subconsciously about drug use and personality change. Robert Louis Stevenson was a cocaine addict who allegedly wrote the book while using. Sir Arthur Conan Doyle depicted the destructive aspects of cocaine in Sherlock Holmes who became addicted.

Pathogenesis Natural History And Clinical Course Of Drug Dependence

There now are several competing conceptual models for the pathogenesis of drug dependence and its natural history, as well as for the clinical course of drug dependence, which is natural history modified by one or more clinical interventions intended to be more than palliative in character. The Jellinek curve'' with its notion of bottoming out'' was among the first of these conceptions a concept applied originally to alcohol, with later extension to other drugs (e.g., in Narcotics Anonymous self-help groups). Many investigators have ignored drug dependence or studied it as if the dependence phenomenon were more or less an extension of the initial levels of drug involvement, for example, by counting up the numbers of occasions of illegal drug use the more the number of occasions, the greater the level of drug involvement, with no incorporation of clinical features of drug dependence such as salience, tolerance, or withdrawal states as described above (e.g., see Brook et al., 2000a, b)....

Beliefs about Drinking Drug Abuse and Bipolar Disorder

I've heard people with bipolar disorder claim that marijuana or cocaine is just as effective as a mood stabilizer such as Depakote in controlling their mood states. They argue that alcohol calms them down, or reduces their anxiety, or improves their depression they argue that marijuana boosts their mood when they are depressed. One patient said, For me, alcohol is like the ropes that keep the hot air balloon from going up . and on the other side is like a disguise covering over the depression. Mistaken Beliefs about Bipolar Disorder and Alcohol or Drug Abuse Hard drugs like amphetamine, LSD, or cocaine can be used as antidepressants Rationalizing their heavy drug use, some people claim that LSD (acid), amphetamines (speed), cocaine (or crack), and Ecstasy are really antidepressants. They argue that these drugs can help their depression more than a standard antidepressant such as Prozac. Some even know about studies showing that LSD stimulates the action of certain serotonin receptors...

Definitive Identification of Cocaine

GC-MS is routinely applied to the identification of cocaine. This is because the technique is both sensitive and of very high resolution. However, this method can 1. The sample is prepared in a suitable solvent, i.e. one which is volatile, free of water and does not react with the analytes, or catalyse their decomposition, and in which the analytes are freely soluble. Methanol or ethanol are generally used for cocaine samples. Such treatment is suggested because of the chemistry of the drugs in question. The ecgonines (cocaine does not derivatize) have free hydroxide and or carboxylic acid moieties. These will sorb onto active and 'dirty' sites within the GC-MS system and also hydrogen-bond with each other in the gas phase in the chromatographic system. This will result in poor mass transfer and hence poor chromatographic behaviour, as observed through tailing peaks. By derivatizing these compounds, the hydroxide and carboxylic acid groups are protected and the problem is thus...

Presumptive Tests for Cocaine

There are a number of presumptive tests for cocaine available from the literature. These are described below. Although there are several presumptive tests available for cocaine and related compounds, none alone is specific to cocaine itself. A very simple test for cocaine is the addition of the material under investigation to a 2 (wt vol) solution of cobalt isothiocyanate in water. The presence of cocaine and related alkaloids results in a blue colour being formed. Interestingly, diamorphine and temazepam also result in a blue reaction, but none of the other opiates or benzodiazepines result in this colour reaction. In addition, a number of local anaesthetics also produce a positive colour reaction. It should be remembered that positive and negative controls should always be undertaken at the same time as the sample is being examined. This is a modification of the cobalt isothiocyanate test, and involves a 2 (wt vol) solution of cobalt isothiocyanate in water, diluted with an equal...

Quantification of Cocaine by GCMS

Table 6.3 Calibration and calculated data, obtained by GC-MS analysis, used for the quantification of cocaine in a drug sample Table 6.3 Calibration and calculated data, obtained by GC-MS analysis, used for the quantification of cocaine in a drug sample Cocaine Cocaine cRatio of cocaine peak area to internal standard peak area. cRatio of cocaine peak area to internal standard peak area. Next, the peak areas of the drugs in the standards are obtained, and the relative responses calculated. Some exemplar standard data for the quantification of cocaine in a drug sample are presented in Table 6.3. Using these, a calibration graph of relative response against cocaine concentration, as the free base, is plotted (Figure 6.3), and from the simultaneous equations and therefore, using the HPLC data obtained from the drug sample, the concentration of cocaine can be calculated.

Scott Reagent for Cocaine

This is a modification of the previous test, with the reagent consisting of a 2 (wt vol) solution of cobalt isothiocyanate in water, diluted with an equal volume of glycerine (1), concentrated hydrochloric acid (2) and chloroform (3). Testing for cocaine is carried out as follows. A small amount of the material is placed in a test-tube and five drops of component (1) added, when a blue colour will develop if cocaine is present. One drop of concentrated hydrochloric acid (2) is then added and the blue colour, if this has resulted from the presence of cocaine, should disappear, leaving a pink solution. Further confirmation is provided by the addition of several drops of chloroform (3), whereupon an intense blue colour will develop in the lower (chloroform) layer if cocaine is present in the original sample material.

Cocaine

Cocaine occurs in abundance in the leaves of the coca shrub and is an ester of benzoic acid and methylecgonine. Ecgonine is an amino alcohol base closely related to tropine, the amino alcohol in atropine. It has the same fundamental structure as the synthetic local anesthetics. The clinically desired actions of cocaine are the blockade of nerve impulses as a consequence of its local anesthetic properties, and local vasoconstriction secondary to inhibition of local norepinephrine reuptake. Toxicity and the potential for abuse have steadily decreased the clinical uses of cocaine. Its high toxicity is due to block of catecholamine uptake in both the CNS and peripheral nervous system. Its euphoric properties are due primarily to inhibition of catecholamine uptake, particularly dopamine, at CNS synapses. Other local anesthetics do not block the uptake of norepinephrine and do not produce the sensitization to catecholamines, vasoconstriction, or mydriasis characteristic of cocaine....

Drug Dependence

Drug dependence can be physical or psychological. The latter refers to addiction to a specific class of drugs. The former is more common and reflects the situation in which the exogenous compound has become a part of the homeostasis of the organism. The hallmark of physical dependence is the appearance of a withdrawal reaction some time after the repeatedly administered drug has been withheld. Symptoms of drug withdrawal can be fairly unspecific, but readministering the drug promptly terminates their presence. Antagonists of the target receptors of the drug do not offer relief but rather can be used to precipitate a withdrawal reaction.

Methamphetamine

Methamphetamine is a highly addictive stimulant that can cause increased alertness and increased physical activity with small doses by causing the release of high levels of the neu-rotransmitter dopamine in the brain. Abusers of metham-phetamine experience a brief rush by smoking or injecting methamphetamine. Oral ingestion or snorting methamphet-amine can produce a high that can last approximately half a day. Due to tolerance, chronic users of methamphetamine may take higher doses of the drug or binge for several days. Long-term use of methamphetamine can cause functional and molecular changes to the brain. Chronic metham-phetamine users may exhibit anxiety, violent behavior, and symptoms of psychosis, such as hallucinations, paranoia, and delusions. Fortunately, the use of methamphetamine in the United States has been decreasing. In 2008, there were approximately 314,000 users of methamphetamine, or half the number of users as in 2006.

Drug Use Is Costly in Many Ways

The personal and societal costs of drugs can be seen around us and in the media. Robert Downey Jr., a well known actor, producer, and singer, had a serious problem with drugs. He described to a judge how he couldn't stop using them even though he knew he was in trouble. He also said that while starring on the television series Ally McBeal, he was at a low point and didn't care if his acting career was over. But after five years of drug abuse, arrests, stints in rehab, and many relapses, he settled down to work on his problem. Ray Charles, the legendary performer, was addicted to heroin, but after his third drug bust, he went into rehab and gave up the drug. Fortunately, there are individuals who generously come forward, tell us their stories, and warn us about drugs. But not all drug users accept treatment or stop taking drugs, and that group generates great concern. There is even greater concern when our peers or the media glamorize drug use, which is quite dangerous. Drug abuse is...

Animal Model Extended

The animal model of drug self-administration (see Figure 2-1) has been critically important for research in drug addiction. Interestingly, our appreciation of the model has continued to evolve. By extending and examining the model more closely, you can study additional aspects or phases of drug addiction. These include the initiation of drug taking or the rate at which an animal learns to self-administer it the maintenance of drug taking, which is the phase where the lever pressing has been learned and is stable or relatively unchanging the extinction of drug taking, which occurs when the lever pressing no longer produces a drug reward and the lever pressing gradually stops and the relapse to drug taking, which is either stress, cue (see the following sidebar), or drug-induced, and occurs when an extinguished subject begins to seek drugs again. These four phases are different and can rely on different processes in the brain. Moreover, certain medications can be more effective in...

Feeling Good The Brains Own Reward System

What do drugs do for us An addict was asked why she injects heroin. Her reply was that it is like a dozen orgasms Although the effects can vary according to the drug, it is safe to say that drugs can make us feel good, or even wonderful. The concepts of pleasure, reward, and reinforcement are so important for drug abuse that we can't leave this topic without describing key discoveries about the brain's own pleasure and reward system. Drugs couldn't produce reward if these capabilities weren't already in the brain.

Superb Observers and a Big Discovery

By carefully mapping the sites of the electrodes in the brain1, they found that there were several regions in the brain that produced this repetitive, reinforcing self-stimulating behavior, and they sometimes referred to these areas as the pleasure center(s). High rates of electrical self-stimulation were found in the lateral hypothalamus, the medial forebrain bundle, and other areas. These anatomical mapping studies have revealed much about the brain regions involved, but for our purposes, we don't need to go into that level of anatomical detail. These regions contain many components that are likely stimulated at the same time, and any one of them can be the contributor to the electrical self-stimulation. Later experiments showed that at least one major component of the medial forebrain bundle supporting electrical self-stimulation was the nerve cells, or neurons, that contain the neurotransmitter dopamine. Electrical self-stimulation of the medial forebrain bundle caused a release...

Demons in the Brain Addiction and Withdrawal

When an individual stops taking drugs and then develops symptoms that are often the opposite of the feelings that the drug produces. For example, an effect of cocaine is mental stimulation, and a symptom of withdrawal from cocaine is depression. Besides making the addict feel terrible, withdrawal is an impetus to relapse to drug use because taking more drugs relieves withdrawal. Fear of withdrawal is also likely to be an impediment to getting treatment. So, withdrawal is a big part of the complex picture that we have been examining. But how does it happen, and how do we think of it However we think of it, we know that repeated drug taking changes the brain and that stopping drug use results in an unpleasant state of withdrawal. Symptoms of withdrawal by drug-dependent subjects can be dramatic, but they vary according to the drug that is used. Withdrawal symptoms for alcohol, for example, include irritability, agitation, craving for more alcohol, insomnia, sweating, diarrhea, rapid...

Gotta Have More and More

With psychostimulants such as cocaine or amphetamine, a reverse tolerance or sensitization can occur. The same dose of drug now produces a greater response instead of a lesser response, and this has been studied in animals. Both tolerance and sensitization are regarded as adaptations of the brain3 to repeated drug taking. Transcription factors are proteins that interact with the parts of the genes called the promoter that controls whether or not the gene is expressed and makes proteins (see Figure 5-4). Our knowledge of transcription factors and how they interact with genes is growing. You can think of a transcription factor as the hand that touches the door knob (which is analogous to the promoter part of the gene) and turns it the opening of the door is like an increase in gene expression. An interesting discovery has been that there are some transcription factors that build up in neurons with repeated cocaine administration. For example, Dr. Eric Nestler and colleagues discovered a...

Drug Use Changes the Activity of the Brain

It isn't surprising, given that drugs change the biochemical makeup of the brain and that drugs change the electrical and metabolic activity patterns in the brain. This was clearly shown by Dr. Linda Porrino and her colleagues who analyzed glucose utilization in monkeys after a few initial doses of cocaine and after many doses (chronic) of cocaine. Glucose utilization is relevant because the parts of the brain that use more glucose do so because they are more active and therefore need more energy. The brain slices shown in Figure 5-5 have dark regions showing where glucose utilization was high. Note that the area of high glucose utilization was enlarged in the slice from an animal treated chronically with cocaine compared to the slice from an animal with only an initial experience with the drug (see Figure 5-5). It is as though drugs take over more and more of the brain gradually, and their influence spreads. Figure 5-5 shows only one slice of brain but the study revealed that many...

Dopamine and Survival

If this hypothesis is true, then it might explain some other puzzling issues. For one thing, if drug addiction is bad, and it obviously is, then why hasn't it been weeded out by evolution Given the survival hypothesis, it hasn't been weeded out because it is intrinsically connected to survival functions like eating and mating. Addiction hooks into mechanisms for natural rewards, and genetic mutations that blunt addictions would have a negative survival impact.

Looking at the Drug Users Brain

Studies using brain-imaging techniques have shown that continued use of drugs causes long-lasting changes in brain chemistry and function. For example, dopamine receptors, specifically the D2 type of receptor, are decreased in the brains of drug abusers who take cocaine, methamphetamine, alcohol, or heroin. When an established addict stops taking cocaine or some other drugs, the D2 dopamine receptor levels do not immediately increase to normal (see Figure 7-2). In fact, they remain suppressed for months and months, and this has proven to be the case in several studies. The low levels of the receptors have suggested that the dopamine system is dysfunctional or under-functioning in these people. In other studies, low D2 levels were also found in obese subjects, echoing the importance of dopamine in natural rewards, and that drugs insert themselves in circuits for natural rewards such as feeding. Thus, low levels of D2 dopamine receptors are a suggestive marker for increased...

So What Can We Do How Does This Help a Drug User

Discovering that drugs change the brain for a long time is one of the most important discoveries in the field. Even though we still don't know how to treat the brain so that the changes revert to normal more quickly or even how to prevent the changes, this knowledge has a big impact in many ways. First, it helps us understand the problem of drug addiction in a basic and mechanistic way. The duration of the changes explain why drug addiction appears to be chronic, and it seems likely that a lack of appreciation of this contributes to relapse. Second, it defines a critical problem in the research laboratory how exactly do the changes occur and how can we block or reverse them If we can block or reverse the brain processes that underlie addiction, then we can treat addicts better. Third, just knowing that the brain is

Does the Brain Ever Get Back to Normal

Michael Nader and his colleagues at Wake Forest University looked at the recovery of D2 dopamine receptors in the brains of five monkeys.5 When the animals self-administered cocaine for some time, their levels of D2 receptors dropped as expected (low D2 levels reflect a propensity to take drugs). The receptor levels were then monitored after cessation of cocaine use for the next 12 months. In three of the five animals, the receptors returned to normal levels by three months (this seems to be faster than it happens in humans). But in two of the monkeys, the levels did not return to normal even after 12 months So there were individual differences in the monkeys in that some reverted to normal and some didn't. This is just like humans. Individual differences in human drug users have long been noted as important. Based on this study's results, you see that all drug users are not the same and treatment has to be flexible to take into account individual...

Vulnerability Who Will Take Drugs

Drug users are a diverse population of individuals, and drug abuse, in general, is a complex process. But, key questions are the following What traits or characteristics do drug users share Can we identify groups or individuals that will become addicts or are in danger of becoming addicts It would be a great thing if we could, because then we could target these people for prevention and treatment. Targeting just this group would likely save lots of money and possibly be more effective because the efforts would be focused rather than broadly aimed and widespread. Figure 8-1 Overall vulnerability to drug use comes from several interacting factors. Let's consider three factors in becoming a drug abuser. First, there is the drug, which might or might not be addicting (hence the + or -), but for our discussion it is an addicting substance. Then there is the person who has a genetic basis that might or might not (hence the + and -) support drug taking. Lastly, there is the complexity of the...

Enriched Environments The Other Side of the Coin

Many laboratories have reported that environmental enrichment reduces cocaine seeking and stress-induced drug taking. In animals already experienced with cocaine (they have learned to self-administer it), environmental enrichment can reduce or even eliminate some addiction-related behaviors. Similar results have been found with other drugs such as heroin. When gene expression was examined in enriched animals (without drugs), many changes were found. Genes for proteins involved in synaptic transmission, protein production, cell structure, and metabolism were affected. These changes in the brain undoubtedly underlie the behavioral changes brought about by environmental enrichment. This work suggests that positive life conditions can change your brain chemistry and can even help addicts stay away from drugs. It is further suggested that positive environments can improve our lives in many, perhaps unexpected, ways. The important message here is that, like drugs, environments and behaviors...

Oxycontin and Other Opiates

The mortality rate for heroin addicts on the street is very high, as it is for users of other drugs as well. Opiates are often used in combination with other drugs. For example, it is often taken after or with cocaine (called a speedball) to quell the agitation and irritability produced by cocaine.

Ecstasy and Club Drugs

Ecstasy, sometimes called X, is an interesting substance that has both stimulant effects like cocaine and amphetamine, but also has hallucinogenic or psychedelic effects like LSD. It is mainly popular among younger drug users, often at dances called raves. Ecstasy used to be considered useful in psychotherapy to promote compassion and insights, but hard data on this is lacking. Its laboratory name is meth-ylenedioxymethamphetamine (MDMA). in increased heart rate and blood pressure, and there have been reported overdoses that have resulted in death. MDMA has diverse effects in the brain. It can block serotonin transporters, resulting in changes in neurotransmission, and it can bind to a variety of neurotransmitter receptors. MDMA is basically an analogue of amphetamine and methamphetamine, and there are other analogues of amphetamine that are abused. For example, MDA has similar properties to MDMA.

Women and Adolescents

A desperate young woman who has been addicted to crack cocaine for some years is considering entering treatment for a second time. The last time, it just didn't work. Maybe I just wasn't ready, she said. I have a very irrational fear of gaining back a lot of the weight that I lost when I started using crack. Extra weight has been a lifelong problem for me and I have a hard time dealing with it. Also, there were many more men than women in her treatment group. Whether they did or not, the men didn't seem to have much sympathy for my problems. She also felt her responses to issues and questions were a little different from the men's, and she withdrew emotionally. I never had much confidence around older men, and for personal reasons, I'm a little afraid of them. But, this time, with the advice of friends, she has decided to ask for a treatment group or program that focuses on women. Maybe this is petty, but I really need all the help I can get right now. The findings with illicit drugs...

Supportive Laboratory Findings

Because of the importance of this topic, there have been many interesting laboratory studies that support the idea of sex differences. For example, female rats show greater behavioral responses than males after cocaine administration. They require lower doses than males to produce the same kind of responses, and the responses last longer than those in males. In cocaine self-administration studies, female rats take cocaine faster and more often than males. There are also sex differences in responses to opiates. Dr. Ann Z. Murphy, her colleagues, and others have noted that morphine is more effective in men than women for treating pain. Interestingly, there are corresponding sex differences in the anatomy of pain pathways in the lower brain and spinal cord. There doesn't seem to be any doubt that females are different from males when it comes to drug taking. The question is Why The thing that comes to mind most readily is that females have different hormones than men. Estrogen is known...

Why Treat Its Too Expensive

There are significant costs of drug use and addiction. Chapter 1, What's in This Book, and Why Should I Read It (see Figure 1-2) shows how the costs of drug use are distributed. If an individual is contemplating treatment, he or she might feel it is too expensive. But on the other hand, the person probably can't afford not to go into treatment. Also, in many cities treatment can be free, at low cost, or on a sliding scale, so cost is not a valid excuse. Even if it was expensive, it is cheaper to treat than not to treat That might be surprising but this is what has been found by several studies on different drugs such as alcohol and cocaine. We have a good idea what the costs are to drug users, their families, friends, and society. Assuming reasonable costs for treatment and reasonable recovery rates for drug users, it is clear that treatment is cheaper than allowing drug users to continue on as they are. Some studies say that the savings over a three-year period are multiples of what...

What Is Successful Treatment

When we say that treatment has been successful, does it mean that the patient never takes the drug again Is it total and permanent abstinence Well, that is certainly the ideal and would be best. The goal of many treatment groups such as Alcoholics Anonymous (AA) is total abstinence, but no one denies that it can be a difficult and lifelong process. Many doctors believe that a reduction in drug use has to be considered at least a partial success. By this book's definition, drug abuse is causing distress and harm in your life, and a reduction of harm, even if not completely eliminated, is a good thing.

Why Treat Them Theyre Only Addicts

This is an important issue and has to do with society's views and attitudes about addicts. Addicts and addiction carry a stigma. Many consider drug use a moral failing requiring something like an awakening, an epiphany or a spiritual rebirth for a cure. Many feel that addiction is something that the individuals do to themselves so therefore they should undo it by themselves. Why bother with addicts Let them figure it out There is a lot of self-righteousness and moralizing in some groups. But research in addiction over the last decades has shown that addiction is a brain-based disorder due to biological and environmental factors. From this perspective, drug abuse is similar to other diseases, such as cardiovascular disease, for example. Drug addiction is similar to cardiovascular disease. The emotional and treatment cost is great. The patients have initiated their disease and are at least partly to blame. They have some control over their behavior, and a lifestyle change is needed....

Principles of Treatment

Drug abuse is complex and is the result of many interacting factors (refer to Chapter 8, Could I Become an Addict , Figure 8-1, which describes these interacting and additive factors). Accordingly, treatment is geared to meet this complexity. If treatment has not worked for someone, then it might not have been done or understood properly. There are several important, general principles that characterize good treatment. Dr. Martin Adler and his colleagues have summarized principles of effective treatment.2 Reading through these provides an idea of what to look for in a treatment plan, or why treatment might have failed in some cases. such as anxiety or depression, should have access to mental health professionals who can effectively manage and treat mental problems. If a person is taking cocaine to curb his or her depression, getting treatment with counseling and medications such as antidepressants will hopefully eliminate that root need or cause of taking the drug. Again, addiction is...

Is Addiction a Metabolic Disease

In spite of these advantages, many still feel that substitutes are not the answer, or that they are short-term solutions at best. Can we justify long-term use of substitutes like methadone in methadone-maintenance programs Most knowledgeable people say that methadone-maintenance is helpful, and this might be an example of where we need to challenge our traditional thinking about the evil of substitutes. In the 1960s, Drs. Vincent Dole and Marie Nyswander saw that addicts compulsively sought out heroin as though they really needed it to function normally. Said another way, drug addiction can be like diabetes in that diabetics require an external source of insulin, which is deficient or not working properly in the bodies of diabetics. This is the notion that addicts, even though perhaps a small fraction of our total population, are seeking to correct a metabolic deficiency in their brains by taking drugs. Dole and Nyswander examined the idea and selected methadone for testing because it...

Best Treatment Is Prevention

Prevention includes the policies and actions taken to prevent new or continuing drug abuse in a target population. If we can prevent the non-drug-using population from becoming drug users, then we can greatly reduce the burden of drug abuse. The idea is to prevent the damage before it occurs. Anti-tobacco and antidrug advertising are examples of prevention efforts. Prevention works For example, two educational programs in schools, Life Skills Training (LST) and the Strengthening Families Program (SFP),6 that are aimed at prevention of drug use have reduced marijuana smoking and alcohol use. The cost of these programs can be just one tenth of a year of outpatient treatment. The youth of this country are not stupid. When told about the problems with drugs, many listen. Figure 13-1 shows a reduction in drug use by youths after being told about the dangers of drugs. Any Illicit Drug Use Any Illicit Drug Use

What Does the Future Hold

One is that a drug addict is someone who has lost (at least some) control over his or her ability to seek and take drugs, and this loss of control leads to distress and problems for the drug user. Almost all drugs that humans abuse are also self-administered by animals, suggesting that drug taking is an innate drive that is widespread in many species. Moreover, many studies show that drug taking is involved with specific physiological systems in the brain. Because drug taking adversely alters brain chemistry, we can develop medications to reverse these negative changes in fact, many useful medications have already been developed. Drug abuse produces long-lasting (months to years) changes in the brain, suggesting that these changes are the basis of the chronic and relapsing nature of drug addiction. Abstaining from drugs for a week or a month after long-term use is probably not enough time for the brain to return to normal and heal. The injury to the...

Treatment Treatment Treatment

Many treatment providers feel that it would be wonderful if we could get what we already know about drug abuse into greater use. Public health would be served greatly if drug abuse prevention and treatment were integrated into primary care across the country. It would mean that a routine visit to the doctor would include screening, treatment if needed, and referrals as part of primary care. It sounds simple, but perhaps the stigma of drug addiction is part of the problem. New and better treatments are also needed to reduce the costly burden of addiction in our society, and the cost is measured not only in money but also in misery. Studies of various treatments and treatment programs will reveal what is most effective in treatment, and these practices will be adopted by other programs. This approach works, but it will take time, money, and support. New medications are needed and will undoubtedly help in this effort. Although there are government-approved and medically accepted...

Molecules of Addiction

Drugs produce changes in the brain, and these changes are in the levels and activity of various molecules in certain neurons. For example, drugs seem to reduce the levels of D2 dopamine receptors, which have been discussed previously. These and other changes form the cellular and molecular bases of addictive behavior. Therefore, knowledge of these molecular events is critical for understanding drug addiction. Understanding a disease does not necessarily mean we can cure it, but it at least defines the problem. This understanding also sets the stage for a possible cure when new techniques and approaches develop over time.

What Should Our Attitude Be and How Can We Help

Some reasonable recommendations9 for combating drug abuse are as follows. Treat drug abuse as a public health problem and support reducing drug use by treatment and prevention education. (This is not saying that drug users who break the law should not be held accountable.) Focus on the collateral damage caused by drugs. This includes the spread of infectious diseases such as HIV and STDs because of bad health practices and poor judgment due to drug use. Support prevention efforts because they are the least expensive way to reduce the costs of drug abuse to society. Prevent use in children, because people who do not use drugs from ages 10 to 20 years of age are unlikely to start using drugs in later life. Support increasing funding for research into the process of addiction, treatment, prevention, and drug policies. Finally, help prevent the stigmatization of drug abusers so that they can more readily get help.

Dopamine and Sexual Behavior

Figure 6-2 Mating results in dopamine release. Dopamine levels (a measure of dopamine release by neurons), indicated by dialysis output on the vertical axis, increased when the male rat was placed in a novel chamber and again when a receptive female was introduced. A subsequent copulation resulted in a sharp increase of dopamine release. Dopamine levels returned to normal after the female was removed from the chamber. Dopamine levels also went up in the brain after rats received an injection of cocaine (refer to Figure 4-5). From the point of view of the brain and the neuron receiving dopamine, the brain doesn't know whether the animal had cocaine or copulated. (Adapted from J.G. Pfaus, G. Damsma, G.G. Nomikos, D.G. Wenkstern, C.D. Blaha, A.G. Philips and H.C. Fibiger. Sexual behavior enhances central dopamine transmission in the male rat. Brain Res, 530 345-348. 1990, with permission from Elsevier.) Figure 6-2 Mating results in dopamine release. Dopamine levels (a measure of dopamine...

How Does Someone Get Help

Family doctors are likely to know how to help, or at least how to begin. There are also several kinds of professionals that specialize in treating drug abusers. This group is the top of the heap in that they have the special training that it takes to assess and address drug problems. School counselors and clergy usually can be counted on to be knowledgeable and keep conversations confidential. They are often among the first to notice drug problems. School officials, in particular, who observe students' performance, often know whether someone is having problems, and they try to help. It is also possible to get information and even find help through the Internet. For example, the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have informative websites. Table 13-2 http www.teen-drug- abuse.org

What Is a Drug

When talking about drugs that can be abused, there are about seven different groups of substances. These are nicotine sedatives such as alcohol, barbiturates, benzodiazepines, and inhalants such as fumes from glue opiates such as heroin and morphine psychostimulants such as cocaine, amphetamine, and methamphetamine marijuana hallucinogens and caffeine. Prescription drugs that are abused comprise many of the previous classes and are shown in the following list Cocaine, which is also known as nose candy, C, and blow Crack (another form of cocaine, and also known as Freebase, Rooster, and Tornado) Methamphetamine (Also known as Crank, Ice, and Stove top) It is useful and can eliminate confusion to make a distinction between the words drugs and medications. The word drug is used in this book to refer to a substance with the potential to cause harm, abuse, and addiction. Of course, there are other drugs that are therapeutic, cure diseases, and are employed by doctors to treat specific...

Other Addictions

Figure 1-3 A lateral (sideways) surface view of the brain shows some of the more obvious regions, and each region has its own function. The specific functions of the various brain regions have become known after centuries of studies of patients with strokes, injuries, and tumors. Drug addiction also involves certain regions. (Adapted from brain.jpg, accessed on December 20, 2010.) Figure 1-3 A lateral (sideways) surface view of the brain shows some of the more obvious regions, and each region has its own function. The specific functions of the various brain regions have become known after centuries of studies of patients with strokes, injuries, and tumors. Drug addiction also involves certain regions. (Adapted from brain.jpg, accessed on December 20, 2010.) The science of genetics has advanced, and it is now possible, with a small sample of blood, to examine our genes. Because genes are the basis of heredity, and some aspects of drug addiction are heritable, studies of genes can be...

Endnotes

1 Throughout this book, we tend to refer to addiction as a disorder, but it is also often called a disease. The definition of addiction that is used in this book focuses on continued drug use in spite of distress and negative consequences. However, the official description is given in the Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association, and it includes more elements. The DSM IV TR is the current edition used by medical professionals for official diagnoses. The DSM is an evolving document and DSM V is due in the near future. Currently, the diagnosis of drug dependence requires the presence of three or more of several symptoms, and it is possible to have a diagnosis of substance dependence without the presence of distress or negative consequences. The official list of symptoms and diagnostic criteria for Substance Dependence and Substance Abuse can be found in an online version of the DSM IV TR. One possible site is which was...

Going Back for More

There are small variations on how to do this, but the idea is that an animal is placed in a sound-insulated chamber to avoid distraction and is then presented with two levers. One activates delivery of a saline solution, the other a saline solution containing a drug such as cocaine. Of course, the animal does not know it is receiving an injection, but it obviously learns that pressing the drug-related lever produces a different sensation than pressing the saline-related lever. Which lever it presses and how often it does so are clear, quantifiable measures of which sensation it prefers (see Figure 2-1). Figure 2-1 Animals will self-administer drugs. The figure shows a rat that has access to levers (only one is visible), and each lever is hooked to either saline (a saltwater solution) or a drug solution such as one with cocaine. The rat also has a catheter or drug delivery tube implanted in its blood vessels. The computer controls how often and how much of the drug is given when the...

The Drug Connection

At this point the self-stimulating rats were injected with varying doses3 of cocaine, and the thresholds of electrical self-stimulation were determined for each dose of cocaine. It turns out that the threshold for self-stimulation varied according to the dose of cocaine given to the rat. The more cocaine that was given, the lower the threshold became. The threshold was lowered significantly at around the dose of cocaine that caused behavioral effects (see Figure 3-3), and this same result was found when other addicting drugs were used in the experiment. Figure 3-3 Electrical self-stimulation can be studied by varying the amount of electrical current that is passed through the electrode. Obviously, if the current is reduced to a very low level, there will be no self-stimulation because the animal won't recognize it. The threshold is the lowest level of current that will result in self-stimulation (refer to Figure 3-1). An injection of cocaine will lower the threshold It is as though...

The Nerve Cell

On the right is a schematic of a nerve terminal containing the neurotransmitter dopamine, which abuts the next cell (post synaptic dendrite). Dopamine is stored in the vesicles, and after an action potential (electrical impulse) invades the nerve terminal, the vesicles merge with the membrane to release dopamine into the synaptic cleft or space. The neurotransmitter diffuses across the synapse and then interacts with the receptors and produces a stimulation (indicated by arrows). Finally dopamine is removed from the cleft by the transporter, which moves it back into the nerve terminal where it is stored in the vesicles again. (The left portion is adapted from http en.wikipedia.org wiki Nervous_system. The right portion is reprinted from Trends in Neurosciences, Vol. 14, M.J. Kuhar, M.C. Ritz, and J.W. Boja, The dopamine hypothesis of the reinforcing properties of cocaine, pp. 299-302, Copyright 1991 , with permission from Elsevier.)

Summary

This chapter describes the basic brain machinery for chemical neurotransmission and how drugs interfere in that process. Directly or indirectly, drugs can do the same thing that neurotransmitters do, such as stimulate receptors, or they can block functions, such as cocaine blocking the transporter for dopamine. When drugs are in the brain, the brain cannot control the drugs like it can control neurotransmit-ters. Drug action in the brain is more under the control of the drug user. This is a significant part of why drugs basically can take over the brain. In the next chapter, we see that drugs, because of this aberrant behavior, can produce significant effects in the brain.

Postmortem Findings

When the brains from addicts that have died are analyzed (referred to as postmortem studies),5 there are many biochemicals whose levels are changed. It still is not clear which chemicals and brain regions are the most significant for drug addiction, but we have many hints. It is likely that changes in many chemicals and many neurons (as opposed to one chemical in one neuron) are required for the addiction process. So, although we don't know the full story, we have at least the beginnings of a story.

Dopamine and Food

Figure 6-1 Brain dopamine (DA) systems. Three major systems contribute to sexual arousal and desire, including the mesolimbic and mesocortical DA system. This system has DA-containing cell bodies in the ventral tegmental area (VTA) with terminals in the nucleus accumbens (NAcc) (and other limbic regions) and medial prefrontal cortex (mPFC), respectively. Other DA systems shown include the diencephalic system and the nigrostriatal system. The tuberoinfundibular DA system controls hormone release from the anterior pituitary gland. These systems control attention and motivation related to sexual and feeding stimuli and are also involved in the regulation of mood and emotions, attention, motivation, reward and reinforcement, and the actions of cocaine. SN substantia nigra mPOA medial preoptic area. (From Figure 3 from Pfaus, James G., Reviews Pathways of Sexual Desire, Journal of Sexual Medicine, Copyright 2009. Reprinted with permission of John Wiley & Sons, Inc.) Figure 6-1 Brain...

Not Only Dopamine

But it wouldn't be accurate to imply that dopamine and its neurons are the sole, powerful players here for all drugs. Dopamine is a major player for drugs such as opiates and psychostimulants, like cocaine and amphetamine. But there are other neurons, circuits, and neurotransmitters in the picture that we have not mentioned or explored.7 For example, Dr. Peter Kalivas, his colleagues, and others have shown that molecular changes in a neuronal pathway from the prefrontal cortex to the nucleus accumbens core underlie cocaine seeking, and this circuit uses the neurotransmitter glutamate.8 It is not just the effects of drugs on a given neurotransmitter, but also the impact of drugs on the specific circuits, brain regions, and their functions that

What About Me

These are risk factors, and risk is not certainty. Risk is about an increased likelihood. Nevertheless, thinking about risk factors can be helpful. If certain factors apply to someone, then he or she has to work extra hard in controlling these and other factors. For example, someone who has a strong family history of drug dependence might have a hereditary vulnerability that, of course, can't be avoided. However, this just means that the person would have to work at other factors like avoiding places where drugs are available, avoiding friends who use, and seeking positive support from counselors, clergy, friends, and family members. The more risk factors that one has, the more vulnerable he or she is. So, working at controlling the risk factors that one can influence is important. Life is short, and strengthening positive and healthy habits will mean a lot. When in risky situations, being aware of the danger of drugs and being prepared to say no to drugs are crucial to combating risk...

Marijuana Cannabis

Marijuana is the most widely used illicit drug. A recent survey by the National Institute on Drug Abuse found that more than 20 percent of high school seniors have used marijuana within the last 30 days Echoing the previous paragraph is the question of whether it's use affects student performance. Marijuana or the hemp plant (cannabis sativa) is often smoked or eaten to get high. A major active ingredient is delta-9-THC (tetrahydrocannabinol), but there are probably others such as cannabidiol. The strength or percent of the plant that is drug has increased over the past few decades, presumably because of selection. Several different strains of the plant are known. Dronabinol (synthetic THC, whose proprietary name is Marinol) is a marketed medication indicated for appetite stimulation and reduction of vomiting. Hashish, an extract of the plant that is a more pure form of the drug, is made of resinous secretions of the plants which are dried, compressed, and smoked. Delta-9-THC and...

Caffeine

We don't think of caffeine as a drug, but it does produce intoxication and withdrawal signs, and it is perhaps the most widely used psy-choactive (mind-altering) substance in the world. It is a stimulant, but it is different from the psychostimulants like cocaine because its mechanism of action is different. It does not affect the dopamine system directly. Rather, caffeine blocks subtypes of receptors for another neurotransmitter, adenosine.

Vaccines

Fitch, R. Rothberg, and C.R. Schuster published a paper in Nature showing that antibodies against morphine blocked the action of morphine on a functioning, contracting tissue.1 Traditionally, antibodies are made against large molecules like proteins, and the generation of effective antibodies against a small molecule like morphine was a significant achievement. Not only were the antibodies produced, they were active in that they bound morphine and prevented morphine from having a biological effect. A simple analogy is restraining someone from reaching and doing something injurious to another person. The antibody binds and restrains the molecule so that it can't do anything. From this seminal study, the idea of producing vaccinations against addicting drugs took hold. For example, it has been shown that vaccinating someone with a protein that has many cocaine molecules attached to it can result in the body producing antibodies against cocaine. The antibody...

Rti336

As we have seen, new medications are needed. Because there are no medications for psychostimulant (including cocaine, amphetamine, and methamphetamine) addicts, this is one area where help is important. As an example, let us consider one possible candidate for a medication, RTI-336.3 For the sake of discussion, let us look at it as a medication for cocaine users, although it can be used for any psychostimulant drug (see Figure 14-2). RTI-336 is the result of an effort of a diverse group of scientists with complementary skills who were searching for a substitute medication for cocaine.4 What are the properties that we would want in such a medication First, it should be less toxic than cocaine. Cocaine acts at many sites in the brain, and a medication that acts only at the addicting site for cocaine would be desirable so that other unrelated actions (side effects) would be avoided.5 Next, cocaine gets into the brain quickly and, depending on how it is taken, can impart the much sought...

Impacting The Problems Of Drug Use Medication Errors

The Epidemic of Prescribed Drug Abuse According to data from the U.S. National Institute on Drug Abuse, in 2006, approximately 7 million persons were current users of psychotherapeutic drugs taken non-medically (2.8 of the U.S. population).16 The main classes of drugs abused that were obtained via legitimate channels through prescribers and pharmacies include

Development Of Other Local Anesthetics

It was only natural that discoveries in organic chemistry, both analytic and synthetic, should have led to efforts to find preparations with good anesthetic properties and without the drawbacks of cocaine. Besides its highly acute toxicity and the risk of addiction (which came to play a greater role as time went by), cocaine is easily decomposed when the solution is sterilized. It is also expensive. As emphasized by Willstatter, the vegetable bases, such as cocaine, are often so complex that the imagination of the chemist is not equal to the task of shaping them without the natural model, at least in our time. The constitutional formula of cocaine and its synthesis were not completed before 1934, 60 years after the isolation of the alkaloid by Niemann. For a long time, the ideas about the structure of the base ecgonine were erroneous, but this did not prevent great progress from being made in the field of new local anesthetics. The points of departure were the discoveries of the...

Understanding Hysteria

Although remaining in the laboratory and making scientific discoveries would have been the surest road to becoming a university professor, and his monographs were beginning to earn him a small reputation, Freud's advancement there was blocked by a lack of openings, and he left research to pursue a private practice in clinical neurology. His move was also compelled by the need to establish an income sufficient to support a family, because he was planning to marry his fiancee, Martha Bernays. During his 3 years of hospital residency at the General Hospital in Vienna, Freud worked in several departments, including internal medicine, neurology, and psychiatry. In psychiatry he worked with Theodor Meynert, the brain anatomist. Freud studied the properties of cocaine, but rather than gain him prestige the work soon discredited him as the dangers of the drug became evident. He had little training in academic psychiatry, which at that time was not interested in the study of patients'...

The First Spinal Anesthetic

James Corning ( Fig. 2-1 ), a New York City neurologist, heard in 1885 of the local anesthetic properties of cocaine, which had been discovered by the Viennese ophthalmologist, Carl Koller, in 1884. 3 Corning began a series of experiments to determine whether local medication of the spinal cord was within the range of practical achievement. He reasoned that cocaine might be the ideal agent to treat neurologic disease if applied in the vicinity of the venae spinales of the cord. If it were delivered to the spinal region, it could be absorbed and carried to the affected area, having a much greater effect, like that of strychnine when it was injected in the same way. His first subject was a dog. Corning injected cocaine below the spinous processes of two of the inferior dorsal vertebrae. After a few minutes, the dog's hindquarters became paralyzed. A short while later, he tried the same technique on a young man with seminal incontinence. The young man received 2 mL of a 3 solution of the...

Continuous Spinal Anesthesia

Seven years after Bier's landmark work on the administration of cocaine via lumbar puncture, Henry Percy Dean, a British surgeon, introduced a modification of the technique called continuous spinal anesthesia.123 Unfortunately, many of his colleagues who attempted the procedure encountered difficulties such as needle trauma and breakage. Therefore, the technique fell into disfavor, as can be evidenced by the lack of citations referring to continuous spinal anesthesia in the English language medical literature from 1907 to 1939.123

Brachial Plexus Block

In 1884, less than a year after the discovery of the anesthetic properties of cocaine, William Halsted performed the first regional blockade of the brachial plexus. His technique involved surgical exposure of the plexus in the neck with subsequent intraneural blocking of individual nerves.143 Effectively providing complete anesthesia to the upper extremity, the procedure itself was, at times, nearly as extensive as the surgery for which it was being provided. Unfortunately, an addiction to cocaine, the very drug that Halsted used to block the plexus, befell him, limiting his ability to popularize his approach.143 143

Three Giants Of The First Half Of The 20th Century

Concurrently, Sigmund Freud was abandoning his early emphasis with neurological approaches to the mind, including experimentation with drugs such as cocaine for the treatment of opiate addiction, and was setting in motion a dynamic depth psychology that eventually captivated American psychiatry. Unfortunately, Freud's psychodynamic approach, which revolutionized our views of how the mind operates with many unconscious instinctual dimensions and urges, did not foster a robust scientific movement to properly evaluate his own blossoming ideas. That, of course, would have been impossible in his day. Initial theory was built upon rather limited clinical observations, and then theoretical constructs were built upon other theoretical constructs, with no clear empirical operationalization or organic foundations. In the opinion of many, the resulting structure ultimately resembled a Tower of Babel, where one could not readily sift the good ideas from the bad. Freud's thesis that most...

Three Great Phases Of 20thcentury American Psychiatry

Following the decline of German medical influence in 1914, the progression of 20th-century psychiatry emerged largely on the Anglo-American scene, at least until the most recent psychopharmacological era when new agents were discovered, around the world, to have more remarkable and specific effects on the psyche than anything discovered since morphine and cocaine. This history can be conveniently broken down into three phases of about three decades each, with the Kraepelinian approach to diagnostics and pathophysiology providing a sustained background theme for all. His systematics matured when effective medicines were discovered to treat most major disorders with the advent of powerful medications for the treatment of schizophrenia, depression, mania, and anxiety in the 1950s. It remains controversial how much each phase advanced the field relative to the ones that preceded it. Nonetheless, each period was distinctive, reflecting, perhaps, an evolving progression of scientific...

Ultrapositivistic Psychopharmacology Era 1970present

The class of drugs known as antipsychotics generally dampens DA activity. Since there are several different DA receptors, modern work has sought to more specifically target the D2 receptors, which are present in abnormally high quantities in the schizophrenic brain. Most antipsychotics are receptor blockers, which means that they prevent dopamine from having normal physiological interactions with its receptor. Other drugs that stimulate receptors are called agonists such drugs can promote schizophrenic symptoms. For instance, the indirect agonists such as cocaine and amphetamines can induce sufficiently strong paranoid symptoms that psychiatrists have difficulty distinguishing them from the real thing.

Directed Neurological Examination

The directed neurological examination should begin with a mental status evaluation, which includes a psychiatric assessment. This part of the examination actually begins during the history and may be expanded in a more formal fashion. The mental status examination should include assessments of level of alertness, orientation, and attention. Stupor may be organic in origin or psychiatric. Hypervigilant states may develop with delirium tremens as well as with drug overdoses, such as amphetamine, phencyclidine, and cocaine, or with paranoid states in general. A fluctuating level of consciousness is more likely to be associated with an organic cause, and the presence of stupor will interfere with the remaining aspects of the cognitive examination. Sudden alterations in behavior, especially behavior with automatisms, may also suggest a seizure disorder seizures of frontal lobe origin may be extremely bizarre, and sudden behavioral changes are often mistaken for psychogenic displays.

Associated Neurological Findings

The clinician should look for evidence of autonomic hyperactivity including the presence of palpitations, cold clammy extremities, sweating, sighing, trembling, or hypervigilance, which can be indicative of anxiety disorders, anxiety associated with neurological diseases, or drug withdrawal syndromes. valvular disease. Both lupus and rheumatic fever may affect the heart valves and can cause a variety of neuropsychiatric syndromes. Subacute bacterial endocarditis, a chronic illness, may present with an abnormal mental state such as depression and mild dementia. Tachycardia may be observed in patients with anxiety and manic disorders. Abdominal examination may reveal evidence of liver disease. The extremities should be evaluated for intravenous track marks, the stigmata of the drug abuser.

Affective Disorder Syndromes

The differential diagnosis of bipolar disorder includes other psychiatric syndromes including schizophrenia and personality disorders. Medical and neurological conditions that may be associated with mania or may be mistaken for bipolar disorder include CNS masses, infections (neurosyphilis, encephalitis), and hyperthyroidism. Steroids, cocaine, amphetamines, hallucinogens, baclofen, bromocriptine, pergolide, methylphenidate, and levodopa may all cause symptoms consistent with mania. Other neurological disorders that may include mania as part of their presentation include multiple sclerosis, head trauma, stroke, temporal lobe epilepsy, and Wilson's disease.

When Seeing Is Believing

In one large-scale study, researchers wanted to see if and how mother-child interactions differed in babies who were exposed to cocaine during pregnancy compared to those who were not. Researchers brought 695 mothers and their 4-month-old babies (236 who had the prenatal exposure to cocaine) into a structured observation setting. In three two-minute periods, the exposed babies' facial reactions (recorded on video) revealed them to be less positively engaged with their mothers than the nonexposed babies. According to the study results, mothers who'd used cocaine appeared to be less synchronized with their babies than non-cocaine-using mothers. The size and controlled conditions used in this study permitted researchers to make informed statements about the association being investigated, but it did not distinguish between the contribution of either the mother or the baby to the diminished synchronization.

Arrhythmias And Anaesthesia

In addition to volatile agents, several drugs used during anaesthesia may facilitate arrhythmias by direct toxicity (e.g. local anaesthetics), autonomic effects (e.g. succinylcholine, pancuronium), by enhancing the effects of catecholamines (e.g. nitrous oxide, thiopental, cocaine), or as a result of histamine release. These are discussed

Is the Disorder Familial

Other studies have shown that the accuracy of family history assessments varies by diagnosis. Thompson et al. (1982) found that sensitivities for major depression and alcoholism were much higher than for generalized anxiety, drug abuse, phobic disorder, and depressive personality. Moreover, diagnoses based on spouse or offspring reports were more sensitive than those based on parent or sibling reports. Kosten, Anton, and Rounsaville (1992) examined the validity of the family history method for five diagnoses used in a family study of opiate addiction depression, anxiety, antisocial personality, alcoholism, and drug abuse. For diagnosing family members, the sensitivities were uniformly low, ranging from 6 to 39 . Specificities were greater than 95 , with the exception of depression, which had a specificity of 54 . The authors also provided data about the type and number of informants. Spouses and children were better informants than parents or siblings. For alcoholism and drug abuse,...

The Provisions of the Misuse of Drugs Act 1971

Social harm, and Class C drugs the least. Class A drugs include cocaine, heroin, mescaline, morphine and opium, Class B includes amphetamine(s), and Class C the benzodiazepines. At the time of writing Cannabis is being reclassified. In addition, stereoisomers, salts, esters, ethers and certain preparations are also controlled groupwise, thus removing the need to name each of these individually. Associated with each class of drug are maximum penalties which may be prescribed. Those for Class A drug offences are more severe than those for Class C offences. For Class A drugs, some offences carry a maximum sentence of life imprisonment, for Class B 14 years in prison, and for Class C, five years in prison. With respect to each of the listed drugs, the Misuse of Drugs Act, 1971 is divided into several sections (Table 1.1), with each section relating to a specific type of offence under the Act which is prohibited.

How Is Illegal Drug Use Assessed

Sometimes there are physical clues of drug abuse such as unexplained seizures, high blood pressure, and rapid or abnormal pulses which may be the result of cocaine abuse. Pupil size in another important clue in the acute drug overdose setting. Evidence of anabolic steroid use, blood doping, or other such practices unfortunately is more difficult to assess on exam alone. Disproportionate muscular hypertrophy or male secondary sex characteristics in the female athlete may provide hints of steroid use.

The Five Control Schedules

Schedule II Drugs Opium or morphine, codeine, synthetic opiates such as meperidine (Demerol), barbiturates such as secobarbital (Seconal), amphetamines, methylphenidate (Ritalin), and phenmetrazine (Preludin) PCP, cocaine, methadone, and methamphetamine have high potential for abuse but are currently accepted for medical use with severe restrictions. Abuse of these drugs may lead to severe psychological or physical dependence.

Government Decision Making

Decisions to add, delete, or change the schedule of a drug or other substance may be initiated by the Drug Enforcement Administration (DEA), the Department of Health and Human Services (DHHS), or by petition from any interested person, such as the manufacturer of a drug, a medical society or association, a pharmacy association, a public interest group concerned with drug abuse, a state, or a local government agency. When the DEA receives a petition, the agency begins its own investigation of the drug.

Reward Deficiency And Neurophysiological Adaption

This model assumes that chemical imbalance is manifested as one or more behavioral disorders called the reward deficiency syndrome (Blum, Cull, Braver-man, & Comings, 2000, para. 3). This disorder, and others like it, are linked by a common biological substrate, a hard-wired system in the brain (consisting of cells and signaling molecules) that provides pleasure in the process of rewarding certain behaviors (Blum et al., 2000, para. 3). He suggests that this reward deficiency syndrome may cause a predisposition, or vulnerability, to addiction that includes alcohol, cocaine, heroin, nicotine, sugar, pathological gambling, sex, and other behavior disorders.

Clinical Research

The origins of regional anesthesia may date back thousands of years. The Incas believed that the coca leaf was a gift from Manco Capac, son of the sun god, who gave it to them as a token of esteem and sympathy for their anguish. Initially used for religious and political purposes, the leaves were used more abusively after the destruction of the Incan civilization in the 16th century by Francisco Pizarro and his conquistadors. The lower classes and slaves were paid with coca leaves, which increased their productivity and provided low-cost, high-output labor. Coca leaves bound into a ball (cocada) with guano and cornstarch were chewed with lime or alkaline ash to release the active alkaloid. Anthropologic documentation of that era indicates that trephination was successful, and cocaine-drenched saliva could be dripped from the physician's mouth onto the wound, thereby providing local anesthesia and pain relief. Cocaine began to receive attention in Europe and America during the mid-19th...

Psychoanalysis Metaphor And The Concept Of Mind

In The Interpretation of Dreams Freud showed that the same pattern was to be found in more complex cases as well. Thus (1900 106ff) his apparently non-wishful dream that his patient Irma was suffering from a toxic injection given by his colleague Otto could be seen as representing the satisfaction of, and thereby pacifying, a desire not to be responsible for Irma's continued suffering, which had been roused by a comment from Otto the day before, which Freud had taken as critical. In representing Otto as giving toxic injections, moreover, Freud seems also to have been pacifying a connected wish which originated years before a wish not to have been responsible for the death of a patient by a toxic drug which he had administered, and that of a friend who had died as a result of injections of cocaine, which drug Freud had recommended to him.3 The pacification of a contemporary and potentially conscious desire concerning Irma went together with that of deeper and presumably more painful...

Visual Hallucinations

Illicit drug use (cocaine, lysergic acid diethylamide LSD , marijuana), medications (digoxin, anticholinergics, and dopaminergics), and parasympatholytic eye drops (atropine) may also be responsible for visual hallucinations. A psychotic psychiatric disorder is suggested when complex visual hallucinations are accompanied by occasional auditory hallucinations. y Normal people may experience both formed and unformed visual images upon wakening (hypnopompic) or upon going to sleep (hypnagogic). A number of degenerative neurological diseases (Parkinson's disease, progressive supranuclear palsy), in the setting of medication use (levodopa, dopamine agonists, monoamine oxidase MAO inhibitors, and anticholinergics) can make visual hallucinations a common clinical disorder. Other disorders such as diffuse Lewy body disease may have visual hallucinations as a primary symptom as well.

Types Of Addictive Disorders

Today, neuroscientists view addiction as a brain disorder expressed in compulsive behaviors. According to Alan Leshner former director of the National Institute of Drug Abuse, The majority of the biomedical community now consider addiction, in its essence, to be a brain disease, a condition caused by persistent changes in brain structure and function (Leshner, 2001, p. 1). Just as ingesting chemicals (alcohol and other psychoactive drugs) activate the pleasure center of the brain, so do compulsive gambling, sex addiction, compulsive eating, compulsive spending, and extreme work.

Evaluation Guidelines Table95

Testing with pilocarpine, cocaine, hydroxyamphetamine chest x-ray study Testing with pilocarpine, cocaine, hydroxyamphetamine chest x-ray study Testing with pilocarpine, cocaine, hydroxyamphetamine chest x-ray study Testing with pilocarpine, cocaine, hydroxyamphetamine chest x-ray study

Psychological implications

Disorders in relation to the CAG repeat of the AR gene demonstrated a significantly higher prevalance in genotypes with shorter repeat chains. The group also reported an association ofshort CAG repeats in the AR gene with novelty-seeking behaviour (drug abuse, pathological gambling) (Comings etal. 1999).

Additional Comorbid Situations Risk Taking Behaviors

It's not unusual for bulimic symptoms to also coexist with other risk-taking behaviors. Many people who develop bulimia also struggle with alcohol and or drug abuse. Some have problems with impulse control and get in trouble for shoplifting and other forms of theft. Many bulimics are also cutters who self-rnutilate at times. (This is also true of anorexics who have a binge-purge variety of the disorder.) If any of these situations applies to you, ifs important to own up to them so that all components of your particular set of challenges will be addressed in therapy's

Are opioids misused by patients

There are some patients who misuse opioids. Several patterns of misuse have emerged. Perhaps the most serious is drug diversion, obtaining prescription opioids and subsequently selling them. Another serious problem is the use of illegal drugs, such as cocaine or methamphetamine in addition to the opioids. Unsanctioned dose escalation is common and can be due to tolerance, poor pain control, or using opioids to treat psychological or other symptoms. Additional aberrant behaviors include seeking prescriptions from multiple physicians and forging prescriptions. However, most patients use their medications appropriately.

What are some of the warning signs that opioids are being abused

Certain actions have been identified as being highly suggestive of addictive behavior. They include selling prescription drugs, forging prescriptions, repeatedly borrowing drugs from friends or family, concurrent use of large amounts of alcohol, use of any illicit street drugs, the loss of prescriptions or pills, seeking prescriptions from other doctors including emergency department personnel, and frequent missed appointments. Other signs that may raise the suspicion of drug abuse include frequent complaints that the dose is too low, requests for specific drugs, unsanctioned dose escalations, or use of the drug to treat other symptoms. However, some of these behaviors may be due to inadequate pain control, sometimes called pseudoaddiction. Despite the best screening, some patients will abuse or misuse opioid analgesics. If abuse or misuse is suspected, the patient should be referred for consultation to a specialist in addiction medicine.

When is the use of longterm opioids considered appropriate in the management of spinal disorders

Long-term opioids are appropriate for spine patients with a well-defined structural stimulus that cannot be definitively treated. The pain level should be consistent with the structural disorder present in the spinal column. Aggressive rehabilitation and other appropriate interventions should be pursued, and their failure to relieve pain should be documented. There should be no significant psychological illness or history of addiction or drug abuse. Opioids should not be used to treat nonspecific back or neck pain.

Additional Resources

J., & Lewis, P. G. (Eds). (1976). Socialization in drug abuse. Cambridge, MA Schenkman. This edited book contains classical articles about the preconditions for using drugs, developmental stages in drug careers, and the implications for society.

Consent of Minors as a Legal Issue

Parent notice or consent for certain health-related conditions (e.g., venereal disease, alcohol, or drug abuse) (see Dekraai et al., 1998). School districts are well-advised to adopt written policies stating that students may be seen by the school psychologist or other school mental health professional without parent notice or consent to evaluate whether the pupil is in danger (e.g., child abuse) or a danger to self or others.