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All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.
This is the tenth volume in the Research Advances series and the seventh published by Plenum Press. Volume 10 is another omnibus volume, providing specialized and advanced reviews in a number of areas related to the use of alcohol, illicit drugs, and tobacco. We include also a brief history of the Center for Alcohol Studies that gives Mark Keller's unique perspective on this noted institution. Two of the chapters are decidedly longer than the others-very long chapters have appeared occasionally in the past, and we think that it is one of the strengths of the series that we are able to accommodate such reviews. Again the editorial board has changed. After several years of service, Reginald G. Smart has stepped down. New to the board are Helen M. Annis, Michael S. Goodstadt, Lynn T. Kozlowski, and Evelyn R. Vingilis. This is likely to be the sole volume for which Goodstadt is on the board, since before completion of this volume he moved from the Addiction Research Foundation to the Center for Alcohol Studies, Rutgers University.
This volume is the eighth in the Research Advances Series and the fifth published by Plenum Press. The purpose of the series is to review new work in rapidly changing fields. We do not expect reviews to cover the whole field of work on alcoholism and addiction. Nor do we expect that they will be like annual reviews covering all work in a delimited field. Our reviews are designed to explore only the most exciting parts of the total field and to focus on conclusions that can be made about them. The series publishes one volume each year. Volume 8 is an omnibus rather than a theme volume in that a wide range of topics is covered, including research on alcohol, opiates, and tobacco. As usual, the greater emphasis is on alcohol research, reflecting the importance of the problem and the volume of work to be reviewed. With Volume 8 come some changes in the Editorial Board. It will be the last volume in the series for Robert E. Popham who has resigned from the Board. He has been with the series since its inception and has contributed a great deal to its development. The members of the Board are grateful for his help. We are adding two new members: Dr. Howard Cappell, whose field is experimental psychology, and Dr. Edward M. Sellers, in clinical medicine and pharmacology.
This book continues the series of reviews of research advances first published in 1974. The editors' aim here is to present critical and integrative reviews by internationally recognized scholars of areas in which there has been much recent research. In this task we have been greatly helped by the staff of Plenum Press and the Advisory Panel listed at the front of this volume. Several members of the Panel have retired: Dr. W.M.D. Paton, Dr. K. Bruun, Dr. K.F. Killam, and Dr. J .R. Seeley. Dr. Klaus Makela has accepted our invitation to join the Panel. Unfortunately, one member of the Panel, Professor William McGlothlin, died as a result of a tragic accident. He was a gifted and sensitive researcher. His work over many years was well known to those studying alcohol and drug problems. We want to acknowledge his contributions to the Research Advances Series and to the field in general. The editors wish to acknowledge the help of Julliana Newell Ayoub in preparation of this volume. This volume contains three papers by H. Fingarette, R. Room, and B. Kissin, on "The Disease Concept." They were originally prepared for an earlier volume but could not be included because of scheduling problems. The editors, and not the authors, are responsible for this delay. Because they are primarily philosophical and theoretical in nature they are not diminished in value by the lesser number of references to recent research.
Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources. The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse. Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children. Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care. The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevanceâ€"to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.
New and improved therapies to treat and protect against drug dependence and abuse are urgently needed. In the United States alone about 50 million people regularly smoke tobacco and another 5 million are addicted to other drugs. In a given year, millions of these individuals attemptâ€"with or without medical assistanceâ€"to quit using drugs, though relapse remains the norm. Furthermore, each year several million teenagers start smoking and nearly as many take illicit drugs for the first time. Research is advancing on promising new means of treating drug addiction using immunotherapies and sustained-release (depot) medications. The aim of this research is to develop medications that can block or significantly attenuate the psychoactive effects of such drugs as cocaine, nicotine, heroin, phencyclidine, and methamphetamine for weeks or months at a time. This represents a fundamentally new therapeutic approach that shows promise for treating drug addiction problems that were difficult to treat in the past. Despite their potential benefits, however, several characteristics of these new methods pose distinct behavioral, ethical, legal, and social challenges that require careful scrutiny. Such issues can be considered unique aspects of safety and efficacy that are fundamentally related to the distinct nature and properties of these new types of medications.
Disorders of anxiety and substance use are, for some reason, rarely treated in an integrated fashion by professionals. This timely volume addresses this glaring omission with dispatches from the frontlines of research and treatment. Thirty-four international experts offer findings, theories, and intervention strategies for this common form of dual disorder, across a range of substances and of anxiety disorders, to give the reader comprehensive knowledge in a practical format.
Over the last decade the world has experienced a growing interest in problems associated with the nonmedical use of drugs. This interest has corresponded to a real growth in the extent, diversity, and social impact of the use of alcohol and drugs in many societies. As a result, the amount of research and writing on the subject of drug problems has greatly increased, and it has become very difficult for one individual to keep up with all the relevant literature. There is thus an acute need in the field for critical reviews that assess current developments, and the present series is intended to fill this need. The series is not to be an "annual review" in the usual sense. The aim is not to cover all the work reported during the preceding year in relation to a fixed selection of topics. Rather, it is to present each year evaluative papers on topics in which enough recent progress has been made to alter the general scope in a particular area. Owing to the multidisciplinary nature of problems of drug use and dependence, the papers published in each volume will be drawn from several disciplines. However, some volumes may be devoted to one partic ular problem, with individual reviews and papers examining various aspects of it. The composition of the editorial board and the international advisory board reflects these objectives. The editors are members of the senior scientific staff of the Addiction Research Foundation of Ontario.