ders. One controversial group of pharmacotherapies for anxiety disorders among patients with drug abuse has been benzodiazepines. They are generally considered safe and effective for a range of anxiety disorders and are among the most widely used pharmacotherapies (Tyrer, 1984). However, there is clear evidence that some benzodiazepines have a significant abuse liability (Sellers et al., 1993). Consequently, the use of benzodiazepines in patients with a history of drug abuse or dependence is often judged to be contraindicated. However, not all benzodiazepines are equally prone to abuse. Medications such as oxazepam, clorazepate, or others with longer duration to onset of peak effect not only might be useful in treating patients with co-occurring anxiety, but may have little risk of abuse when taken orally. Studies to determine the usefulness of benzodiazepines with slow onset to peak effects for patients with drug abuse and anxiety disorders would be helpful in providing data on this issue.

Additionally, since U.S. drug abusers often abuse multiple drugs, studies are needed to determine the interactions among drugs of abuse, medications used to treat drug dependence, and medications used to treat comorbid psychiatric and medical disorders. For example, a medication intended to prevent relapse to cocaine dependence should be tested for adverse consequences when used in combination with alcohol or opiates since these drugs are commonly used together. This is an area in which the behavioral models discussed in Chapter 2 could make significant contributions.

Further, pharmacokinetic studies of medications are typically carried out in healthy individuals, whereas many drug abusers have multiple health problems. Thus, the interactions among abused drugs, medications for drug abuse or dependence, and medications for psychiatric and medical problems may be altered in drug abusers. To optimize treatment strategies and to prevent adverse health outcomes, pharmacokinetic studies are needed to determine these possible interactions. Additionally, comparative studies of pharmacotherapies and psychotherapies for specific, well-defined depressive or anxiety disorders with this population (drug abuse and psychiatric disorders) could provide important data about the most appropriate therapies.

Special Populations

There is a dearth of research on drug-abusing women, prisoners, and adolescents. For reasons discussed below, it is extremely important for those populations to gain access to, enter, and remain in treatment. Most of the research opportunities center on treatment access, retention, and

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