DISSOCIATIVE DRUGS This section discusses ketamine, phencyclidine (PCP), and dextromethorphan (DXM). Nitrous oxide is an inhalant with dissociative properties and is discussed in greater detail later in the chapter. All four of these substances share the pharmacological property of being…
NEUROBIOLOGY AND GENERAL CHARACTERISTICS Stimulants refer to a heterogeneous class of substances with the action of stimulating the central nervous system, primarily through noradrenergic and dopaminergic effects. The stimulants discussed in this chapter include amphetamines, methamphetamines, methylphenidates, cocaine, cathinones, 3,4-methylenedioxymethamphetamine…
GENERAL CHARACTERISTICS Cannabis is the most commonly illicitly used drug in the United States, as well as globally. The cannabis plant contains over 100 different cannabinoids, molecules that share their chemical structure with delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the two…
NICOTINE PHARMACOLOGY Chemical Structure and Mechanism of Action of Nicotine The nicotine molecule is a tertiary amine alkaloid with pyridine and pyrrolidine rings, and it exists in two enantiomeric forms. The S-enantiomer is a more potent agonist at the nicotinic…
BRIEF HISTORY OF THE CURRENT OPIOID EPIDEMIC Beginning in the early 1800s, opium and morphine use became widespread; opiate-containing “patent medicines” were heavily marketed for several medical conditions, especially toward women. Morphine prescribing peaked in 1890, and in 1898, Bayer…
GENERAL CHARACTERISTICS Sedative/hypnotics are a diverse class of central nervous system (CNS) depressants with addictive liability and a wide range of therapeutic functions. Benzodiazepines are the most widely prescribed medication among sedative/hypnotics, and they are also the most widely prescribed…
GENERAL CHARACTERISTICS AND HISTORY Evidence of alcohol consumption has been noted as far back as 9,000 years ago by Neolithic farmers in Northern China, and recipes for producing alcohol have been discovered worldwide for thousands of years. Dr. Benjamin Rush…
GENERAL TERMS AND CONCEPTS Following initiation of substance use, using is typically impulsive and a positively reinforcing experience. The chronic and repeated use of it leads to possible tolerance accompanied by diminishing returns on the substance’s positively reinforcing effects. In…
PSYCHIATRIC COMORBIDITIES OF SUBSTANCE USE DISORDERS When thinking about the psychiatric manifestations of substance use disorder (SUD), one has to differentiate between: 1 The substance’s effects: Drugs and alcohol intoxication or withdrawal cause psychiatric signs and symptoms that are part…
DEFINITIONS OF SUBSTANCE USE DISORDERS AND DIAGNOSTIC EVALUATIONS Although persons with a substance use disorder (SUD) use drugs or alcohol, using these substances does not necessarily mean that a given person meets SUD diagnostic criteria. Indeed, in 2012, the American…