Aspects of Substance Abuse

The RAND Corporation is one of the world s oldest and best known think tanks. Over the years RAND has produced numerous studies and reports on various aspects of substance abuse. There is a page devoted to this topic on the organization s web site at http //www. rand.org/research areas/sub-stance abuse/. 

Brust JCM (1993) Neurological Aspects of Substance Abuse. Boston Butterworth-Heinemann. 

Jaffe JH Drug dependence opioids, nonnarcotics, nicotine (tobacco), and caffeine, in Comprehensive Textbook of Psychiatry, 5th Edition, Vol 1. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams c Wilkins, 1989, pp 642-686 Jaffe J, Knapp CM, Ciraulo DA Opiates clinical aspects, in Substance Abuse A Comprehensive Textbook. Edited by Lowinson JH, Ruiz P, Millman RB, et al. New York, Lippincott Williams and Wilkins, 2004, pp 158—165 Jarvis MA, Schnoll SH Methadone use dming pregnancy. NIDA Res Monogr 149 58— 77, 1995... 

This chapter is organized somewhat differently than previous chapters. Because there are so many aspects of the clinical course and treatment that are conunon to all substances of abuse, we will first review the features of substance abuse and dependence that are common to all substances. This will include a general description of risk factors, clinical course, evaluation, and treatment recommendations. What follows is a review of treatment recommendations specific to each substance of abuse. 

David E. Nichols, Robert Oberlender, and Dennis J. McKenna. "Stereochemical Aspects of Hallucinogenesis." In Biochemistry and Physiology of Substance Abuse, vol. Ill, edited by R. R. Watson, pp. 1-39. Boca Raton, FL CRC Press, 1991. 

In this chapter, we will focus primarily on treatments for the substance use disorders. However, because detoxification during a substance-induced withdrawal is often the first step in treating a substance use disorder, we will discuss withdrawal states to some extent. The substance use disorders include both substance abuse and the more serious substance dependence. Substance abuse consists of a pattern of misuse that causes recurring problems in at least one aspect of life. This can be a failure to fulfill responsibilities at home or work, reckless use of the substance such as drunken driving, repeated substance-related arrests, and ongoing substance use despite resulting problems in family relationships. See Table 6.1 for the diagnostic criteria for substance abuse. 

Note AIDS is caused by HIV, which impairs both cellular and humoral immune functions, and this results in increased susceptibility to opportunistic infection and certain malignancies. The medical aspects of HIV infection include AIDS-related complex (weight loss, chronic diarrhea, fever, thrush, herpes zoster, fatigue), opportunistic infections and cancer, end-stage renal disease, blindness (cytomegalovirus), HIV encephalopathy, and dementia. The psychological aspects of HIV infection include major depression, regression, and suicidal impulses, delirium, substance abuse, antisocial personality, and bereavement. 

Manno JE, Ferslew KE, Manno BR. Urine excretion patterns of cannabinoids and the clinical application of the EMIT-dau cannabinoid urine assay for substance abuse treatment. In Agurell S, Dewey WL, Wfilette RE eds. The cannabinoids Chemical, pharmacologic, and therapeutic aspects. San Diego Academic Press Inc, 1984 281-90. 

Drugs can wipe out microorganisms that attack our body. However, some drugs can be abused resulting in an individual becoming dependent on the medication. Substance abuse is the most publicized aspect of pharmacology—and the one least understood by patients and healthcare professionals. This chapter explores drugs that are commonly abused and discusses how to detect substance abuse. 

There are two primary sources for the information in this section. In 1998, ONDCP supported a study by the National Academy of Sciences Institute of Medicine (lOM) on marijuana s potential benefits and harms. In one of the quotes from Drug Czar John Walters in an earlier section of this chapter, he refers to a result from this study. The lOM report is one source for the information reviewed here. The second source is a book titled Cannabis Use and Dependence Public Health and Public Policy (Cannabis Book). The authors are from the University of Queensland (Australia) and the RAND Corporation s Drug Policy Research Center, a well-respected organization that receives a lot of federal grant money in the substance abuse area. The Cannabis Book contains an impressive review of literature on all aspects of marij uana use, effects, and policy. In a review appearing in aprofessional journal, this book was described as ... the most comprehensive and honest attempt to improve the quality of the public policy debate on cannabis. " While it is probably not possible for any source to be completely objective, these documents seem to be very balanced and no discemable bias could be detected. 

The diversion and abuse potential associated with controlled substances warrants extensive record keeping involving every aspect of the controlled substances, from manufacturing to acquisition to dispensing to disposal/destruction. Purchasers are required to keep complete and accurate records for each controlled substance manufactured, purchased, received, distributed, dispensed, or otherwise disposed of for 2 years. All records must be available to the DEA for inspection and copying. All records and inventories of Schedule II controlled substances must be maintained separately from all other records of the registrant. All records and inventories of Schedule III-V controlled substances must be maintained either separately from all other records or in such a form that the information is readily retrievable from the ordinary business records at the time of DEA inspection. 

Gaulier, J.M. Tonnay, V. Faict, T. Sayer, H. Marquet, P. Lachatre, G. (2003) Analytical aspects of volatile substance abuse (VSA). Journal of forensic science 48,4,1-3. 

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