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This chapter discusses the role of dopamine in addiction. Research over the past 50 years has revealed that the mesocorticolimbic dopamine system has an essential role in the acute reinforcing effects of psychostimulant drugs and a contributory role in the acute reinforcing effects of nonstimulant drugs of abuse. Mesocorticolimbic dopamine systems contribute to motivational withdrawal and relapse with all drugs of abuse, and dopamine, by interacting with key elements of brain hormonal stress systems, also has a prominent role in individual differences for the vulnerability to initiate aspects of stimulant addiction that may extend to other drugs of abuse.

This chapter begins with a discussion of the relationship between acute dopamine (DA) increases in the human brain and drug reinforcement. It then covers the long-term effects of drugs of abuse on DA in the human brain, and treatment implications.

This chapter presents an integrated, moral-therapeutic perspective on crime and punishment. It begins by noting how the morality-therapy dichotomy constricted classical debates about punishment. Using as examples kleptomania (compare compulsive gambling) and drug abuse (compare alcoholism), it is shown how serious crime can be both a wrongdoing and a sickness. These examples are familiar in debates about therapeutic approaches to crime, and they provide continuity with the preceding discussions of addictions. The chapter then discusses the possibility of extending a moral-therapeutic approach to other serious crime, and concludes with comments on legal insanity.

This chapter summarizes studies examining the link between drugs of abuse and the behavioral neurobiology of aggressive behavior in animal models. It considers studies examining how drug abuse affects the aggressive response patterns of animals, as well as the development, activity, and function of neural systems implicated in aggression control. It shows that the effects of many commonly abused drugs, illegal and prescribed, on aggression are dependent upon the sex and species of the animal, the dosing and treatment regimen, and the behavioral testing paradigm. Although very few drugs, or drug classes, have been shown to consistently influence aggressive behavior regardless of the aforementioned factors (i.e., species, age, sex, dosing, testing paradigm), there are notable exceptions, including some anabolic androgenic steroids (AAS), nicotine, 3,4-methylenedioxymethamphetamine (MDMA), and mescaline. The administration of various types of AAS has consistently increased aggression in various animal species of varying ages regardless of experimental paradigm, whereas nicotine, MDMA, and mescaline have been shown to consistently decrease aggressive responding.

This chapter details the epidemiology of use and abuse of alcohol, tobacco, and recreational drug use among gay and bisexual men in the United States. The review highlights the history of use and abuse of these drugs over the past quarter century and identifies where there are substantial health disparities regarding use of drugs and where the evidence suggests that gay and bisexual men may not use drugs differently than heterosexual men. The chapter also reviews available programs to address substance abuse issues among gay male communities and areas where the field might best move forward.

This chapter begins with a discussion of the notion that dopamine (DA) transmission provides a neurochemical mechanism of reinforcement in the brain. It then covers the molecular mechanisms of action of addictive drugs, Pavlovian conditioning, addictive drugs and cellular models of learning and plasticity, and dopaminergic mechanisms in the vulnerability to drug addiction.

Drug testing has emerged as many employers' answer to the problem of employee substance use. Drug-testing programs seek to provide an objective basis for mandatory employee referral to treatment programs, prevent the onset of drug use among abstaining workers, diminish productivity losses and workplace accidents ascribable to substance use, minimize cost increases for employer-paid health care expenses, and decrease drug-related work turnover. In short, drug testing endeavors to identify or prevent the development of problems in order to maintain a healthy and safe workforce. Despite these admirable goals, drug testing programs do not appear to accomplish these aims, and require considerable expense. In order to understand how drug testing promotes worker health and safety, this chapter examines the literature on the effectiveness of drug testing in the identification of workers whose substance-use impairs job performance.

Opioids, which have long been abused, are capable of producing euphoria and other “positive” subjective effects. Although the relationship between positive subjective effects and abuse of a drug is not necessarily causal, there is a predictive relationship between those drugs that produce a positive spectrum of subjective effects and their likelihood of functioning as reinforcers and being abused. A host of factors influence the subjective effects of opioids (and subsequently their abuse liability); some of the more salient ones are covered in this chapter. It first describes how subjective effects of opioids are measured and then discusses how such factors as dose, route of administration, rate of onset of drug effects, tolerance and dependence, and drug use history can all influence an opioid's subjective effects.

This chapter shows that significant progress has been made in developing the methodological tools needed to assess variations in incidence rates of drug use and prevalence trends over time. Topics discussed include the current scope of drug use, population prevalence estimates, trends in drug use, prevalence of drug use by young persons, trends in youth drug use, variations in drug use within populations, injection drug use, and individual trajectories and drug use careers. Drug use and its related problems do not occur randomly. Some nations and some neighbourhoods are more likely at times to experience high rates of drug use, and some individuals are more likely to initiate and continue heavy drug use. The fact that problem drug use is most often interwoven in a complex network of other social problems, both at the individual level and at the societal level, implies that strategies to prevent drug use or drug-related harms need to address this complexity.

This chapter rounds up the discussion of Richard M. Nixon's role in illicit drug use in the United States. It can be noted that Nixon was re-elected partly due to his administration's approach to law and order concerns, as well as drug abuse and crimes related to it. It first studies one of the most controversial 1972 initiatives of Nixon, the Office of Drug Abuse Law Enforcement (ODALE), which served to allow the federal government to help local government units prod addicts to enter treatment and enforce drug laws. It then turns to the issue of legalizing marijuana and the efforts that were put in place to catch attention for Nixon's anti-narcotics programs. This chapter also looks at Nixon's other efforts to solve the drug use issue, the collaboration between ODALE and the Special Action Office for Drug Abuse Prevention (SAODAP), and the de-emphasis process for the 1972 federal drug abuse control policy. The chapter ends with a discussion of Nixon's resignation on August 8, 1974.

This chapter reviews studies of sex differences in drug abuse. There is increasing preclinical and clinical evidence that gonadal hormones play a role in the subjective effects, reinforcing effects, and other effects of abused drugs. Despite this growing evidence, most studies that include women ignore the menstrual cycle. Until more studies are conducted to provide sufficient evidence that the subjective effects of a particular drug do not vary across the menstrual cycle, studies comparing males and females need to control for menstrual cycle phase in a systematic fashion.

This chapter describes the use and misuse of cannabis. Marijuana is the most commonly consumed illicit drug, with 200 to 300 million users worldwide. Approximately one-third of Americans have tried the substance at least once. Despite its popularity, few people smoke marijuana regularly. Less than 5% of Americans report using the drug every week. Estimating the number of users is difficult because people lie or forget about their use. The amounts that people consume are also hard to estimate. A variety of definitions of misuse of the drug exist that include addiction, dependence, abuse, and problems. Addiction does not have a universal definition, making the term difficult to use scientifically. Abuse and dependence are diagnosed reliably and can clearly apply to problem marijuana users. Nevertheless, the abuse and dependence diagnoses may not provide the clear information one might learn from a simple list of marijuana problems.

This chapter discusses drug use during President Lyndon Johnson's term. It notes that by the end of Johnson's presidency, several measures that would soon form a response to drug use were already in place. It looks at the confusion and concern of the public over the issue and examines the “marihuana consensus.” The chapter then takes a look at the three areas that Johnson's staffers focused on, namely the rationalization and reform of the entire body of current drug law, the creation of the Bureau of Drug Abuse Control and the Bureau of Narcotics and Dangerous Drugs, and the improvement of access to treatment for noncriminal and criminal drug users alike. The Comprehensive Drug Abuse Prevention and Control Act of 1970 and the Narcotics Addict Rehabilitation Act are also covered.

This chapter turns to American drug use during Richard M. Nixon's first years as President. It illustrates the increasing problem through statistics, identifies the five measures that Nixon promised would help solve the situation, and explains how Nixon's administration planned to use foreign policy to fix a domestic issue. The next sections focus on the Turkish poppy ban (Turkey being one of the major suppliers for heroin in the United States), drug use among enlisted U.S. personnel, and the complicated nature of narcotics control policy. This chapter then turns to the Comprehensive Drug Abuse Prevention and Control Act of 1970, which initially presented generally lower penalties with regards to marijuana, removed the death penalty, and classified basic possession offenses as misdemeanors. Other efforts to thwart drug use were the Controlled Dangerous Substances Act of 1969 and Operation Intercept.

Drug users receive help from a variety of health and social services that have been specifically developed for them and that are reviewed in Chapter 9. This chapter moves up one level of analysis to consider service programmes in the context of larger systems and their population-level impact. It discusses how health and social service programmes interact with each other and with the more generalized types of service programmes that drug users commonly access, for example those that provide vocational training, welfare benefits, and emergency health care. It also discusses how service systems are organized, funded, and managed.

Psychoactive substances have assumed increasing public attention in most parts of the world, especially when they are defined broadly to include alcohol, tobacco, illicit drugs, and certain types of legal pharmaceutical agents that have high dependence potential. The effects these substances have on individuals and society depend on a variety of factors, including the pharmacological properties of each drug, the way the drugs are ingested, their cultural meanings in everyday life, the reasons for using them, and the harms associated with their misuse. Public discussion of drug policies has too often failed to take these complexities into account. Simplistic views that all drugs are the same and all are equally dangerous not only limit our understanding of drug-related problems but also impair our ability to develop meaningful policy responses. Advances in psychiatry, psychology, neurobiology, cultural anthropology, epidemiology, and a variety of other disciplines have substantially increased our understanding of psychoactive drugs, drug actions, and drug misuse. This chapter addresses these fundamental ‘matters of substance’ in order to set the stage for the chapters to follow.

This chapter examines the use of drugs—both legal and illegal–by pregnant women, noting increased medical and legal supervision of pregnancy and women’s substance use and abuse. Many states require health care professionals to report pregnant women who admit to, or are suspected of, using alcohol or other drugs. The result can be involuntary detention commitment for “treatment.” Women have been prosecuted for homicide after they suffer a stillbirth despite weak evidence that the stillbirth was caused by drug use. Prosecution of these women is counterproductive, because it drives pregnant drug users underground, away from both prenatal care and drug treatment.

Based on alumni interviews, this chapter reports on the mental and physical health functioning of alumni, thus providing more empirical data about the short-term and long-term functioning of maltreated youth who were placed in foster care. The primary hypothesis was that alumni would exhibit mental and physical health difficulties that would be more severe than those of the general population.

For many policymakers, researchers, and ordinary citizens, drug use per se is less of a concern than the problems that accompany it: chronic health problems, infectious disease transmission, property crime, and family breakdown, to name only a few examples. This chapter summarizes what is known about the extent of the health risks and social harms associated with drug use. Illicit drug use is associated with a marked burden of disease, disability, mortality, criminality, and a variety of other social harms. Although the burden, harm, and costs attributable to illicit drug use are substantial, for most countries they are lower than those attributable to alcohol and tobacco. Only in established market economies is illicit drug use among the major risk factors for the burden of disease. In low- and middle-income countries, illicit drug use is a minor consideration in the overall burden of disease, but this could change with rising incomes and increasing globalization.