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Contents

Section One

Drug Use in Modern Society

1 Drug Use: An Overview

“The Drug Problem”

UseIsNotAbuse

EveryDrugHasMultipleEffects

AmountMatters

PsychoactiveDrugEffectsArePowerfullyInfluencedbytheUser’sHistoryandExpectations

Drugs,PerSe,AreNotGoodorBad

How Did We Get Here?

Drugs and Drug Use Today

ExtentofDrugUse

PopulationsofUsers

TrendsinDrugUse

Correlates of Drug Use

RiskandProtectiveFactors

DeviantDrugUse

Race,Gender,andLevelofEducation

PersonalityVariables

Genetics

AntecedentsofDrugUse

GatewaySubstances

MotivesforDrugUse

Summary

Review Questions

References

Check Yourself: Do Your Goals and Behaviors Match?

2 Drug Use as a Social Problem

Land of the Free?

Toxicity

CategoriesofToxicity

DrugAbuseWarningNetwork

HowDangerousIstheDrug?

Blood-BorneDiseases

Substance Dependence: What Is It?

ThreeBasicProcesses

ChangingViewsofAddiction

WhichIsMoreImportant,PhysicalDependenceorPsychologicalDependence?

Broad Views of Addiction

IsAddictionCausedbytheSubstance?

IsDependenceBiological?

IsTherean“AddictivePersonality”?

IsDependenceaFamilyDisorder?

IsSubstanceDependenceaDisease?

Crime and Violence: Does Drug Use Cause Crime?

Why We Try to Regulate Drugs

Summary

Review Questions

References

Check Yourself: Are You Hooked on an Activity?

Check Yourself: What’s Your Risk of Drug Toxicity?

3 Drug Policy

The Beginnings

Reformism

IssuesLeadingtoLegislation

1906PureFoodandDrugsAct

HarrisonActof1914

TwoBureaus,TwoTypesofRegulation

Regulation of Pharmaceuticals

Purity

Safety

Effectiveness

MarketingaNewDrug

DietarySupplements

Controlled Substances

AftertheHarrisonAct

NarcoticControlActof1956

DrugAbuseControlAmendmentsof1965

ComprehensiveDrugAbusePreventionandControlActof1970

Anti-DrugAbuseActsof1986and1988

State and Local Regulations

Federal Support for Drug Screening

MilitaryandFederalEmployees

TransportationWorkers

PrivateEmployers

PublicSchools

TestingMethods

The Impact of Drug Enforcement

Budget

InternationalPrograms

OtherFederalAgencies

OtherCosts

EffectivenessofControl

Summary

Review Questions

References

Check Yourself: Consider the Consequences

Section Two How Drugs Work

4 The Nervous System

Homeostasis

Components of the Nervous System

Neurons

Glia

Neurotransmission

ActionPotential

The Nervous System(s)

SomaticNervousSystem

AutonomicNervousSystem

CentralNervousSystem

The Brain

ChemicalPathwaysImplicatedinReward

Structures

Drugs and the Brain

LifeCycleofaNeurotransmitter

ExamplesofDrugActions

Chemical Theories of Behavior

Brain Imaging Techniques

StructuralImaging

FunctionalImaging

WordofCaution

Summary

Review Questions

References

5 The Actions of Drugs

Sources and Names of Drugs

SourcesofDrugs

NamesofDrugs

Categories of Drugs

Drug Effects

Nonspecific(Placebo)Effects

Dose-ResponseRelationships

Potency

Time-DependentFactorsinDrugActions

Getting the Drug to the Brain

ALittle“Chemistry”

RoutesofAdministration

TransportintheBlood

MoreabouttheBlood-BrainBarrier

Mechanisms of Drug Actions

EffectsonAllNeurons

EffectsonSpecificNeurotransmitterSystems

Drug Deactivation

Mechanisms of Tolerance and Withdrawal Symptoms

Summary

Review Questions

References

Section Three Uppers and Downers

6 Stimulants

Cocaine

History

CocaWine

LocalAnesthesia

EarlyPsychiatricUses

EarlyLegalControlsonCocaine

FormsofCocaine

ContemporaryLegalControlsonCocaine

MechanismofAction

AbsorptionandElimination

BeneficialUses

CausesforConcern

SuppliesofIllicitCocaine

CurrentPatternsofCocaineUse

Amphetamines

History

BasicPharmacology

BeneficialUses

CausesforConcern

Summary

Review Questions

References

7 Depressants and Inhalants

History and Pharmacology

BeforeBarbiturates

Barbiturates

Meprobamate

Methaqualone

Benzodiazepines

NonbenzodiazepineHypnotics

Mechanism of Action

Beneficial Uses

Anxiolytics

SleepingPills

Anticonvulsants

Causes for Concern

DependenceLiability

Toxicity

PatternsofAbuse

Inhalants

GaseousAnesthetics

Nitrites

VolatileSolvents

Gamma Hydroxybutyric Acid

Summary

Review Questions

References

8 Medication for Mental Disorders

Mental Disorders

TheMedicalModel

ClassificationofMentalDisorders

Treatment of Mental Disorders

Before1950

Antipsychotics

AtypicalAntipsychoticDrugs

Antidepressants

ElectroconvulsiveTherapy

MoodStabilizers

Consequences of Drug Treatments for Mental Illness

Summary

Review Questions References

Check Yourself: Track Your Daily Mood Changes

Section Four

Alcohol

9 Alcohol

Alcoholic Beverages

FermentationandFermentationProducts

DistilledProducts

Beer

Wine

DistilledSpirits

Alcohol Use and “The Alcohol Problem”

TheTemperanceMovementinAmerica

Prohibition

ProhibitionWorked!

ProhibitionIsRepealed

Regulationafter1933

Taxation

Who Drinks? And Why?

CulturalInfluencesonDrinking

TrendsinUS AlcoholConsumption

RegionalDifferencesintheUnitedStates

GenderDifferences

DrinkingamongCollegeStudents

Alcohol Pharmacology

Absorption Distribution

Metabolism

Mechanism(s)ofAction

Behavioral Effects

Time-Out

DrivingundertheInfluence

SexualBehavior

Blackouts

CrimeandViolence

PhysiologicalEffects

Alcohol Toxicity

AlcoholPoisoning

Hangover

ChronicDiseaseStates

Fetal Alcohol Syndrome

Alcohol Dependence

WithdrawalSyndrome

AlcoholUseDisorder

Summary

Review Questions

References

Check Yourself: Do You Have a Drinking Problem?

Section Five

Familiar Drugs

10 Tobacco

Tobacco History

EarlyMedicalUses

TheSpreadofTobaccoUse

Snuff

TobaccoinEarlyAmerica

ChewingTobacco

Cigars

Cigarettes

Tobacco under Attack

TheQuestfor“Safer”Cigarettes

ElectronicCigarettes

TobaccoProductsandtheFDA

CurrentCigaretteUse

SmokelessTobacco

Hookahs

Causes for Concern

AdverseHealthEffects

SecondhandSmoke

SmokingandHealthinOtherCountries

SmokingandPregnancy

Pharmacology of Nicotine

AbsorptionandMetabolism

PhysiologicalEffects

BehavioralEffects

NicotineDependence

How to Stop Smoking

Summary

Review Questions

References

Check Yourself: Test Your Tobacco Awareness

11 Caffeine

Caffeine: The World’s Most Common Psychostimulant

Coffee

Tea

Chocolate

Other Sources of Caffeine

SoftDrinks

EnergyDrinks

Over-the-CounterDrugs

Caffeine Pharmacology

TimeCourse

MechanismofAction

PhysiologicalEffects

BehavioralEffects

Causes for Concern Cancer

ReproductiveEffects

HeartDisease

Caffeinism

Summary

Review Questions

References

Check Yourself: How Much Caffeine Do You Consume?

12 Dietary Supplements and Over-the-Counter Drugs

Dietary Supplements

Some Psychoactive Dietary Supplements

SaintJohn’sWort

SAMe

Ginkgo biloba

Weight-Control Products

Over-the-Counter Drugs

FDA Regulation of OTC Products

Simplifying Labels

Over-the-Counter versus Prescription Drugs

Behind-the-CounterDrugs?

Some Psychoactive OTC Products

Stimulants

Weight-ControlProducts

SedativesandSleepAids

Analgesics

PeopleandPain

Aspirin

Acetaminophen

IbuprofenandOtherNSAIDs

Cold and Allergy Products

TheAll-Too-CommonCold

TreatmentofColdSymptoms

AllergyandSinusMedications

Choosing an OTC Product

Summary

Review Questions

References

Check Yourself: Can You Guess What These OTC Products Are Used For?

Section Six

Restricted Drugs

13 Opioids

History of Opioids

Opium

Morphine

Heroin

OpioidAbusebeforetheHarrisonAct

AbuseaftertheHarrisonAct

AbuseofPrescriptionOpioids

Pharmacology of Opioids

ChemicalCharacteristics

MechanismofAction

Beneficial Uses

PainRelief

IntestinalDisorders

CoughSuppressants

Causes for Concern

DependencePotential

ToxicityPotential

MisconceptionsandPreconceptions

Summary

Review Questions

References

14 Psychedelics

Animism and Religion

Terminology and Types

Indoles

Catechols

N-Methyl-DL-Aspartate (NMDA)

Antagonists

PCP

AnticholinergicPsychedelics

Amanita Muscaria

Salvia Divinorum

Summary

Review Questions

References

15 Cannabis

Cannabis, the Plant

Preparations from Cannabis

Extracts

Edibles

History

EarlyHistory

HarryAnslinger’sCaseagainstMarijuana

TheMarijuanaTaxActof1937

AftertheMarijuanaTaxAct

Pharmacology

CannabinoidChemicals

Absorption,Distribution,andElimination

MechanismofAction

PhysiologicalEffects

BehavioralEffects

Medical Uses of Cannabis

Causes for Concern

AbuseandDependence

ToxicityPotential

Marijuana and American Society

Summary

Review Questions

References

16 Performance-Enhancing Drugs

Historical Use of Drugs in Athletics

AncientTimes

EarlyUseofStimulants

Amphetamines

InternationalDrugTesting

AmericanFootball

Steroids

TheBALCOScandal

TheBattleoverTesting

Stimulants as Performance Enhancers

Steroids

PsychologicalEffectsofSteroids

AdverseEffectsontheBody

Regulation

Other Hormonal Manipulations

Beta-2 Agonists

Creatine

Getting “Cut”

Summary

Review Questions

References

Section Seven

Prevention and Harm Reduction

17 Preventing Substance Abuse

Defining Goals and Evaluating Outcomes

Types of Prevention

Prevention Programs in the Schools

TheKnowledge-Attitudes-BehaviorModel

AffectiveEducation

AntidrugNorms

DevelopmentoftheSocialInfluenceModel

DARE

ProgramsThatWork

Peers, Parents, and the Community

PeerPrograms

ParentandFamilyPrograms

CommunityPrograms

PreventionintheWorkplace

What Should We Be Doing?

Summary

Review Questions

References

Check Yourself: Do Your Goals and Behaviors Match?

18 Rethinking Drug Policy: What Works, What’s Possible, and What’s Feasible

Impetus for Change

Drug Decriminalization

Uncommon Strategies to Enhance Public Health and Safety

DrugPurity-Testing

Heroin-AssistedTreatment

SafeDrugConsumptionSites

Concluding Remarks

Summary

Review Questions

References

Appendix A Drug Names

Appendix B Resources for Information and Assistance

Glossary

Index

List of Boxes

Drugs in the Media

Fentanyl

Don’t Be Fooled by Pretty Pictures

Marijuana Brownie Overdose?

How the Myth of the “Negro Cocaine Fiend” Helped Shape American Drug Policy

Alcohol in Movies

Tobacco Use in the Movies

Natural Male Enhancement?

If There Isn't a Heroin Epidemic, Why Do the Media Keep Saying There Is?

Psychedelics: Back in Mainstream Medical Research?

From Crack Babies to Marijuana Babies: Here We Go Again

Marijuana Legalization Presents a Unique Challenge for the NFL Are Antidrug Media Campaigns Effective?

Taking Sides

Drug Tests for Welfare Recipients?

Attention-Deficit/Hyperactive Disorder and Stimulant Medications: Who Benefits?

Protecting the Unborn from Alcohol

Caffeine Use Disorder?

Should Naloxone Be Made Available to Opioid Users?

Do You Think the Federal Government Should Fund Psychedelic Research?

Federal Medical Cannabis Law Is Inconsistent with State Laws

Using Stimulants as Cognitive Enhancers: Where Do You Stand?

Montana Meth Project: Popular but Doesn’t Decrease Drug Use

Drugs in Depth

Important Terms–and a Caution!

Determining the Extent of Substance Use and Abuse

Drugged Driving

Americans in Prison

Drug Interactions

Seeking Tranquility

Smoker’s Face

Caffeine Shampoo for Hair Loss?

The Caffeine Craze: Buying a Dream

Caffeine and Panic Attacks

Abuse of OTC Dextromethorphan

Prescribing Pain Medications: Damned If You Do and Damned If You Don’t

Extrapolating Findings from Animals to Humans: What You Need to Know

Nutritional Ergogenic Aids

Are We Better Off for Exaggerating the Horrors of Methamphetamine?

Targeting Prevention

Date-Rape Drugs

Falling Asleep without Pills

Estimating Blood Alcohol Concentration

Unintended Consequences

Reporting on the “Drug du Jour”

Syringes and the Harm-Reduction Approach

Viewing Addiction as a Brain Disease Facilitates Social Injustice Drugs and Capital Punishment x

New Drugs Developed and Tested by Companies That Profit from Their Approval

Synthetic Cannabis: The Devil You Know or the One You Don’t With a Girlfriend Like Her, You Don’t Need Enemies

Myth Buster

Meth Mouth: Fact or Fiction?

Using Drugs to “Cure” Mental Disorders

Amphetamine: Baseball’s Real Performance-Enhancing Drug

Life Saver

Keeping Inexperienced Users Safe

Amphetamine and Sleep

Combining Depressants with Alcohol or Opioids

Signs of Alcohol Poisoning

Acetaminophen and Liver Damage

Hidden Ingredients

Opioids: Less Hysteria and More Useful Information

Targeting the Pain

DSM-5

Psychiatric Diagnosis of Substance Use Disorders

Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

Anxiety Disorders

Schizophrenia

Bipolar I Disorder

Major Depressive Disorder

Focus on Drug Policy

Is There Really a “War on Drugs”?

“Purple Drank”

Should Pregnant Drug Users Keep Their Children?

Alternative Approaches: Portugal, Uruguay, and Thailand

Focus on Treatment

Behavioral Treatments for Stimulant Use Disorders

Treating Alcohol Use Disorder

Medication Treatments

Medication Treatments for Cannabis Use Disorder

About the Authors

Dr. Hart is the chair of the Department of Psychology and Dirk Ziff ProfessorinPsychiatryatColumbiaUniversity.Hehaspublishedextensively intheareaofneuropsychopharmacologyandcontinuestolectureonthetopic ofpsychoactivedrugusethroughouttheworld.

Dr. Ksir is professor emeritus of psychology and neuroscience at the University of Wyoming. Now retired after 35 years of research and teaching, he has authored or coauthored Drugs, Society and Human Behavior since 1984.HecontinuestoteachaclassbasedonthistextviatheInternet.

Preface

Today’s media-oriented college students are aware of many issues relating to drug use. Nearly every day we hear new concerns about the “opioid crisis” legal pharmaceuticals, and the effects of tobacco and alcohol, and most of us have had some personal experience with these issues through family, friends, or co-workers. This course is one of the most exciting students will take because it will help them relate the latest information on drugs to their effects on society and human behavior. Students will not only be in a better position to make decisions to enhance their own health and well-being, but they will also have a deeper understanding of the individual problems and social conflictsthatarisewhenothersmisuseandabusepsychoactivesubstances.

Much has changed in the 40 plus years since Drugs, Society and Human Behavior was first published. The 1970s were a period of widespread experimentation with cannabis and psychedelics, while the 1980s brought increased concern about illegal drugs and conservatism, along with decreased use of alcohol and all illicit drugs. Not only did drug-using behavior change, but so did attitudes and knowledge. And, of course, in each decade the particulardrugsofimmediatesocialconcernhavechanged:LSDgavewayto angel dust, then to heroin, then to cocaine. In the 1990s, we saw increased useofLSDandcannabis,butnottothelevelsofthe1970s.

Recent Trends

The most alarming trend in recent years has been the increased misuse of heroin and prescription opioid pain relievers such as Oxycontin and Vicodin. This class of drug has now replaced cocaine as the leading cause of drug overdose deaths in the United States (not counting alcohol overdoses), and it inspiredanewWhiteHousetaskforceonopioidaddiction.

Meanwhile, our old standbys, alcohol and tobacco, remain with us and continue to create serious health and social problems. Regulations undergo frequent changes, new scientific information becomes available, and new approaches to prevention and treatment are being tested, but the reality of substanceuseandabusealwaysseemstobewithus.

This text approaches drugs and drug use from a variety of perspectives behavioral, pharmacological, historical, social, legal, and clinical which willhelpstudentsconnectthecontenttotheirowninterests.

Special Features

Updated Content in the Seventeenth Edition

Throughout each chapter, we have included the very latest information and statistics,and theDrugsintheMediafeaturehasallowedustocommenton breaking news right up to press time. In addition, we have introduced many timely topics and issues that are sure to pique students’ interest and stimulate classdiscussion.

The following are just some of the new and updated topics in the seventeenthedition.

Statisticsondrugusetrends,newdrugtreatments,anddrug-related mortalitystatisticsfromNationalSurveyonDrugUseandHealthand DAWN(Chapter1andthroughout)

ToxicitydatafromtheDrugAbuseWarningNetwork(Chapter2)

Informationonthecostofcurrentdrugcontrolstrategies(Chapter3)

Introductiontotheconceptofneuropeptides(Chapter4)

Informationonhowracialdiscriminationpersiststodayinthe enforcementofcocainelaws(Chapter6)

Updatedtablescontaininginformationonantipsychoticand