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Opening New Vistas in Basic and Preclinical Addiction Research

A Retrospective View on the Hallmarks of Neurobiological Alcohol and Drug Abuse Research What were the major achievements in the past in neurobiologically oriented alcohol and drug abuse research? This can only be answered by a very personal view. I would like to illustrate this in terms of the hallmarks of alcohol research. In 1940, Curt Paul Richter reported that laboratory rats voluntarily consume alcohol, although…

The Homeless

Introduction Understanding the composition and needs of the homeless represents a major challenge for all researchers and providers, not least for a group endeavoring to present a chapter summarizing available knowledge about this complex population. Starting with seemingly simple questions, such as defining homelessness, and moving to much more complex questions, such as treatment and other interventions for this population with multiple needs and problems, numerous…

Disability and Addiction

Acknowledgments My work on this project was supported by the National Center for Advancing Translational Sciences, Clinical and Translational Science Awards Program via a career development award from the New Jersey Alliance for Clinical and Translation Science (grant KL2TR003018 [P.I. Qiana L. Brown]), the National Institute on Drug Abuse grant T32DA031099 (P.I. Deborah Hasin, PhD), and TrendologyIT Corporation. I also acknowledge Dr. Charlene Le Fauve for…

Forensic Issues

Introduction Forensic psychiatry is the branch of psychiatry that addresses the intersection of psychiatry and the law. In the practice of medicine, psychiatry, and a variety of other clinical professions, legal or forensic issues are commonly encountered. Confidentiality, for instance, is a key legal and ethical concern in general medical and psychiatric practice but is subject to special treatment in certain addiction treatment settings, which may…

Alcohol and Drugs of Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action, and Maternal Treatment

Introduction Several drugs and chemicals are known to be teratogenic to the human embryo when administered throughout pregnancy, especially during the period of organogenesis. The evidence for their teratogenicity has been shown by human epidemiologic and clinical studies as well as in studies carried out in animals such as rats, mice, rabbits, and primates. The most important disadvantage of the animal models used is the interspecies…

Identification and Treatment of Alcohol or Drug Dependence in the Elderly

Introduction Substance abuse and dependence are considered significant problems in society, warranting identification and treatment. However, substance misuse, abuse, and dependence in older adults are complex issues that are often not recognized and, if recognized at all, are undertreated. Substance misuse/abuse, in particular, among elders is an increasing problem. Older adults with these problems are a special and vulnerable population that can benefit from elder-specific strategies…

Substance Use Disorders in Health Care Professionals

Introduction The impact of licit (i.e., alcohol and nicotine used legally) and illicit (including nonmedical prescription) drug use, abuse, and dependence in the United States is well documented in the general population. Overall, a 2006 survey reported that an estimated 20.4 million Americans 12 years of age or older were current illicit drug users, meaning they had used an illicit drug—defined as “marijuana/hashish, cocaine (all forms),…

Alcohol and Substance Abuse in African Americans

Introduction Substance abuse is being increasingly appreciated for contributing to overall mortality and morbidity in the United States. Yet, at the same time, substance use continues to be criminalized, especially for African Americans. Disparities in morbidity and mortality across ethnic groups continue to persist. Mortality rates for African Americans are about 1.6 times higher than those for whites, with much higher disparities for certain causes, such…

Enhancing Positive Outcomes for Children of Substance-Abusing Parents

Introduction Adolescent behavioral health problems are on the rise worldwide, particularly for impulse control disorders (ICDs) including substance abuse, delinquency, obesity, and HIV/sexually transmitted diseases (STDs) for genetic and environmental reasons. Contributing to these developmental issues are children growing up in families of substance abusing, depressed, highly stressed, and dysfunctional parents. Even simple things such as the diminishing number of family meals eaten together has been…

Dynamic and Systems-Based Models for Evaluating Hypotheses Related to Predicting Treatment Response

Acknowledgments This work was made possible by grants from the National Center for Research Resources (P20 RR016479) and the National Institute of Mental Health (R15 MH077654). The author thanks Dr. Parthasarathi Nag for helpful comments on an earlier version of this chapter. Introduction Approaches to treating alcohol dependence are heterogeneous, ranging from group therapy in 12-step programs to pharmacotherapy. Such treatment heterogeneity is a reflection of…

In Silico Models of Alcohol Dependence Treatment: A Stochastic Approach

Introduction In the past two decades, computer simulation and computer-aided design have made dramatic progress in all areas of development of complex engineering systems. A prime example is the Boeing 777 jetliner, which has been recognized as the first airplane to be 100% digitally designed, assembled, and tested preflight in silico , (i.e., in a computer simulation environment). This virtual design has eliminated the need for…

In Silico Models of Alcohol Kinetics: A Deterministic Approach

Introduction In recent years, the mathematical representation of physiological systems and its use in computer simulations have come of age. Initially restricted to pharmacokinetics and pharmacodynamics studies, they are now used in many different fields of medicine (e.g., diabetes and metabolic syndrome) to explore previously inaccessible metabolic markers, develop candidate treatments, and even to obtain authorization of regulatory agencies for clinical research, thereby bypassing animal testing.…

Religiousness, Spirituality, and Addiction: An Evidence-Based Review

Introduction The 12-step model to the treatment of addiction is the most popular therapeutic model in the United States, and most adherents of the 12-step approach consider spiritual growth singular with recovery. This chapter offers a critical review and discussion of spirituality and religiousness as it has been investigated in the empirical literature on addiction. Curiously, although the 12-step model has been reported to produce outcomes…

Substance Use Stigma As a Barrier to Treatment and Recovery

Introduction Stereotypes and judgments about people with substance misuse problems are extremely prevalent and negative. The content of these stereotypes varies, with examples including “people who use drugs are immoral,” “alcoholics are unreliable,” or “addicts are dangerous.” These negative evaluations are held not only by those who abstain from substance use, but also by those who themselves use and abuse substances. As the criminalization of drug…

Quadruple Diagnosis: Substance Use Disorder, Comorbid Psychopathology, Human Immunodeficiency Virus Infection, and Hepatitis C Virus Infection

Introduction Comorbid substance use disorders (SUDs) and other psychiatric disorders (dual diagnosis) in individuals who are infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are common. Prevalence rates of such dual diagnoses vary significantly across reported studies, ranging from 10% to 50% or more, depending on the sample assessed. In a large cross-sectional study, up to half of the clients in an HIV-dedicated…

Physical Considerations for Treatment Complications of Alcohol and Drug Use and Misuse

Introduction The effects of chronic ingestion of alcohol and other substances of abuse vary considerably and depend on the concentration and dose, together with various other factors, such as nutritional status, gender, and ethnicity. The present chapter analyzes the main medical consequences related to substance abuse, particularly abuse of alcohol, nicotine, opioids, cocaine, amphetamine, and benzodiazepines. The effects of these substances on the liver, gut, pancreas,…

Molecular Genetics and the Treatment of Addiction

Overview Substance use disorders represent complex phenotypes that result from the intricate interplay of genetic variation, neurobiological mechanisms, psychosocial variables, and environmental variables. To date, one of the least-studied factors has been genetic variation. However, basic research on the human genome is progressing at a rapid pace, and investigations of genetic factors that influence the etiology and treatment of substance use disorders are now much more…

Hallucinogens

Acknowledgments The authors greatly appreciate the editing assistance of medical student Sean Doherty of Cardiff University School of Medicine. Historical Perspectives Psychoactive substances derived from botanicals have been used ritualistically used for millennia. Developments during the second half of the 20th century in neuroscience and in synthetic organic chemistry recast natural and synthetic intoxicants into a new biological and clinical light. These chemicals, referred to improperly…

Potential Pharmacotherapies for Cannabis Dependence

Acknowledgments This research was supported by the National Institute on Drug Abuse grant #DA-03746. We gratefully acknowledge the efforts of Michaela Bamdad and Catalina Saldaña, who read an earlier version of the manuscript and made helpful suggestions. MG thanks the Instituto de Salud Carlos III for making his contribution possible through a Rio Hortega grant (CM18/00168)ISCIII/FSE Introduction Cannabis, which comprises Δ 9 -tetrahydrocannabinol-containing products including marijuana…

Methamphetamine

Mechanism of Action Methamphetamine is an indirect monoamine agonist that increases intracellular and extracellular levels of the monoamine neurotransmitters, dopamine, serotonin, and norepinephrine. Methamphetamine gains entry into neurons either as a substrate at plasmalemmal neurotransmitter transporters or via diffusion across the plasmalemmal membrane as a result of its high lipophilicity. Once inside the presynaptic nerve terminal, methamphetamine inhibits neurotransmitter uptake at the vesicular monoamine transporter-2 located…