Index

A

Abuse liability, 15, 38-39

benzodiazepines, 211

Abuse/use of drugs, terminology, 3, 16-17, 18-19, 95

Access to treatment, 193

gender differences, 212, 213

HIV/AIDS care, 205-206

managed care systems, 231-235

levo-α 15, 29, 71, 195-196

Addiction. See Dependence

Addiction Severity Index, 201-202, 239

Affective disorders, 82, 181

African Americans, 99, 110, 125, 126-127, 128

Age-based differences developmentally appropriate interventions in families, 150

drug-taking behavior, 96-99

life course of drug use, 108-109

Alcohol

agonist/antagonist therapies, 70, 71, 195

biochemical markers, 121

as drug, 2-3, 16-17

drug interactions, 173

drug-seeking behaviors in withdrawal, 66-67

extent of dependence, 102

intergenerational transmission, 119

neural substrate of withdrawal, 67-68

neurochemical reinforcement, 65

physiological protective factors, 121

prenatal exposure, 169-170

tolerance, 66

tolerance as etiological factor, 121

violence linkages, 177-178

Aldehyde dehydrogenase, 121

gamma-Aminobutyric acid (GABA), 58, 178

Amphetamines

neurochemical response, 64

neurotoxicity, 83

Animal models, 35

behavioral research, 37

drug abuse effects on course of HIV, 83

fetal drug exposure, 168

genetic research, 78-79, 80-81



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Pathways of Addiction: Opportunities in Drug Abuse Research Index A Abuse liability, 15, 38-39 benzodiazepines, 211 Abuse/use of drugs, terminology, 3, 16-17, 18-19, 95 Access to treatment, 193 gender differences, 212, 213 HIV/AIDS care, 205-206 managed care systems, 231-235 levo-α 15, 29, 71, 195-196 Addiction. See Dependence Addiction Severity Index, 201-202, 239 Affective disorders, 82, 181 African Americans, 99, 110, 125, 126-127, 128 Age-based differences developmentally appropriate interventions in families, 150 drug-taking behavior, 96-99 life course of drug use, 108-109 Alcohol agonist/antagonist therapies, 70, 71, 195 biochemical markers, 121 as drug, 2-3, 16-17 drug interactions, 173 drug-seeking behaviors in withdrawal, 66-67 extent of dependence, 102 intergenerational transmission, 119 neural substrate of withdrawal, 67-68 neurochemical reinforcement, 65 physiological protective factors, 121 prenatal exposure, 169-170 tolerance, 66 tolerance as etiological factor, 121 violence linkages, 177-178 Aldehyde dehydrogenase, 121 gamma-Aminobutyric acid (GABA), 58, 178 Amphetamines neurochemical response, 64 neurotoxicity, 83 Animal models, 35 behavioral research, 37 drug abuse effects on course of HIV, 83 fetal drug exposure, 168 genetic research, 78-79, 80-81

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Pathways of Addiction: Opportunities in Drug Abuse Research new drug development, 41 recommendations for research, 5, 87 relapse behavior, 69 Antiaddiction medications, 27, 29. See also Pharmacotherapy Antisocial personality, 123, 181 Anxiety disorders, 211 Arachidonic acid, 59 Assessment instruments, 201-202, 239 B Barbiturates, 66 Behavioral research in abuse liability research, 38-39 on aggression and violence, 47-48 behavioral models, 36-37 contributions of, 3-4, 35 craving response, 46-47 economic modeling, 49-50 future prospects, 50-51 learning and conditioning in treatment models, 41-42 on motivation for drug use, 43-45 neuroscience research and, 37-38 for pharmacotherapies, 39-41, 203 recommendations for, 4, 51 risk factors for drug use, 48-49 on withdrawal, 42 Benzodiazepines, 211 antagonists, 70 Biomarkers, 121, 173-174 Bromocriptine, 71 Buprenorphine, 195-196 C Ca2+ neurotransmitter pathway, 59, 60 Cannabis. See Marijuana Cerebral blood flow measurement, 73 Children/adolescents antismoking campaigns, 145-146 community-based preventive interventions, 146 confidentiality issues in treatment, 270 consequences of prenatal drug exposure, 170-171, 174-175 developmental risks in drug use, 8, 166-167 epidemiological surveys, 99-101, 106 parental drug abuse, 175 peer risk factors, 125-126 predictors of adult substance abuse, 122-123 preventive intervention design, 140 racial differences in drug use, 128 risk factors, 128-129 school-based prevention programs, 141-143, 147-149, 152 treatment considerations, 214-215 Clonidine, 68, 70, 71 Clorazepate, 211 Cocaine aggressive behavior and, 47 antiaddiction medications, 203 brain glucose metabolism in use of, 73 craving response in users, 46-47 day hospital vs. inpatient treatment, 240-241 dopaminergic effects, 37, 64, 73, 82 drug interactions, 173 effects on male reproduction, 174 extent of abuse, 2, 21, 193 extent of dependence, 102 immunization, 39-40, 85 market characteristics, 260 maternal use during pregnancy, 166, 167 neurochemical response, 61, 64, 68 pharmacological antagonists, 70 prenatal exposure, 171-172 treatment vs. drug control/interdiction, 199-200 violence linkage, 178-179 withdrawal, 67, 68 See also Crack cocaine Cognitive-behavioral psychology, 42, 196 Community Epidemiology Work Group, 105

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Pathways of Addiction: Opportunities in Drug Abuse Research Conditioned behavior, 41-42 in drug tolerance, 66 See also Reinforcement Confidentiality issues recommendations for research, 270 treatment program enrollment, 268-269 treatment-seeking behaviors of adolescents, 270 treatment-seeking behaviors of pregnant women, 269-270 Consequences of drug use, 159-161 economic costs, 1-2, 22, 167 fetal/child development, 166-175 gender differences, 212-213 health-related, 1, 7-8, 21-22. See also HIV/AIDS intensity of drug use and, 3, 18 violent behaviors, 8-9, 22, 176-182 Contingency contracting/management, 41-42, 196-197 Controlled Substances Act, 254, 257 Correctional systems drug offender population, 263 treatment in, 213-214 Corticotropin releasing factor, 68 Cost-benefit analysis drug control/interdiction vs. treatment, 199-200 managed drug abuse care, 227-228, 239-241 preventive interventions, 149 treatment, 198-200 treatment matching, 209 Cost-shifting, 243-244 Crack cocaine, 163 maternal use during pregnancy, 166 violent behavior and, 179 Craving, 46-47 Crimes/criminality criminalization of drug users, 254- 255 drug abuse treatment for prisoners, 213-214 drug arrest/prosecution trends, 262-263 drug-associated, 176-177, 178 drug use in pregnancy as, 213, 269- 270 effects of criminal sanctions on drug use, 261-266 therapeutic role of criminal sanctions against drug use, 266- 268 Cyclic adenosine monophosphate (cAMP), 59, 60, 66, 68-69 Cyclic guanosine monophosphate, 59 D Dependence addiction and, 19 clinical features, 19 co-occurring psychiatric disorders, 82-83, 108 diagnosis, 192-193 epidemiological data, 101-102 goal of neuroscience research, 56 medical model, 20-21, 26-27 neurochemical systems in, 61-62, 65, 68-69 pain mechanisms and, 4-5 preventive interventions targeted at transition to, 148, 152 relapse risk, 19-20 vulnerability genes, 78-79 Depression, 82-83, 123 with co-occurring dependence, treatment for, 210 drug abuse treatment and, 16 Detoxification, 194-195 Diagnostic and Statistical Manual of Mental Disorders-IV,18, 19, 107, 192, 201 dependence diagnosis, 295-298 Diffusion-weighted imaging, 81 Domestic violence, 178 Dopaminergic system, 37-38, 62, 64-65, 67, 70, 71, 73, 76-77, 79, 82-83, 172 Drug, definitions of, 2-3, 16-17 Drug Abuse Reporting Program, 197-198

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Pathways of Addiction: Opportunities in Drug Abuse Research Drug Abuse Warning Network, 106 Drug control activities, 10-11 abuse reduction vs. medical use, 253-254 arrest/prosecution trends, 262-263 confidentiality of treatment programs, 268-269 cost-effectiveness, vs. treatment, 199-200 criminalization of users, 254-255 deterrent effects of criminal sanctions, 261-266 as drug abuse research topic, 250-251, 270-271 effects on illicit markets, 259-261 effects on legitimate drug use/research, 257-259 enforcement strategies, 255-256 epidemiological studies, 107 prohibition vs. discouragement, 252-253 recommendations for research on effects of, 259, 261, 268, 271 researchable issues, 251-252 severity of penalties, 256 spending for, 22, 259 therapeutic role of criminal sanctions, 266-268 treatment vs. punishment, 256-257 Drug discrimination model, 36-37 Drug effect expectancies, 41, 48-49 Drug self-administration, 3, 36, 48 abuse liability prediction, 38-39 craving and, 46-47 dependence and, 66-67 dopamine transport in, 37-38 for pharmacological therapy evaluation, 40-41 Drug testing, 113 Drug Use Forecasting Program, 103-104 DSM-IV. See Diagnostic and Statistical Manual of Mental Disorders-IV Dynorphin, 68 E Employee assistance programs, 228 Epidemiologic Catchment Area Program, 108, 181 Epidemiology benefits of, in drug use research, 5, 15, 95-96 community-level assessments, 105 conceptual framework, 94-95 data collection needs, 107 data on natural history of drug use, 108-109 drug use by military personnel, 104-105 drug use by pregnant women, 105, 166 drug use by youths, 99-101 drug use of arrested persons, 103-104 general population surveys, 96-102 HIV/AIDS research opportunities, 164-165 HIV transmission, 8 methodological issues, 111-113 metropolitan area studies, 102-103 opportunities for enhancement, 107-113 prevalence trends, 99 psychiatric comorbidity studies, 101-102, 107-108 research recommendations, 5, 113-114 scope, 94 self-reported data, 112-113 social-cultural factors, 109-111 subpopulation surveys, 102-105 terminology, 95 Ethanol. See Alcohol Etiology approach to drug use research, 5-6, 117-118 behavioral models, 36-37 contextual/environmental factors, 124-127 genetic vulnerability, 119-120 medical model, 20-21

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Pathways of Addiction: Opportunities in Drug Abuse Research physiological vulnerability, 120-121 psychosocial vulnerability, 122-124 recommendations for research, 6, 130-131 research goals, 118 research opportunities, 127-130 sociocultural factors, 109-111, 126-127 See also Motivation for drug use Excitatory amino acids, 38, 58-59, 82, 86 Extent of drug abuse, 2, 21, 193 among psychiatric-disordered patients, 108, 123-124 demographic variables, 96-99 general population surveys, 96-102 specific population surveys, 102-105 F Families high-risk, 150 parental drug abuse, 176 preventive interventions, 143-145, 149-150 protective factors enhancement, 128, 143 risk factors, 124-125, 129 Fetal alcohol syndrome, 170 Fetal drug exposure, 8 alcohol, 169-170 cocaine, 171-172 health effects, 167 HIV transmission, 163 life span effects, 174-175 marijuana, 171 multiple drug use, 173 nicotine, 168-169 obstacles to quantifying effects of, 167-168 opiates, 170-171 opportunities for research, 172-175 paternal drug use, 174 prevalence of maternal drug use, 166 recommendations for research, 176 windows of biological vulnerability, 172-173 See also Pregnancy, drug use in Functional magnetic resonance imaging (fMRI), 72, 81 Funding of research, 1 obstacles to interdisciplinary research, 30 sources, 13-14, 22 stability of, 24-25 G G proteins, 59, 60, 61 Gender differences access to care, 212, 213 drug dependence, 96-99 drug-taking behavior, 96-99 psychiatric comorbidity, 212 treatment implications, 212-213 Genetics adoption studies, 120 alcohol-related violence, 178 drug-induced adaptations, 75, 76 etiological factors, 119-120 individual differences in drug response, 62-64 knock-out technology, 79 research opportunities, 78-79 transgenic engineering, 79-80 twin studies, 119-120 H Hallucinogens, 65 violent behavior associated with, 179-180 Harrison Narcotics Act, 253, 254 Health Care Financing Administration, 10, 231 Health maintenance organizations, 223-224, 228-229 Heroin, 105 craving response in users, 46 extent of abuse, 2, 21, 193 immunization, 39-40, 85

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Pathways of Addiction: Opportunities in Drug Abuse Research market characteristics, 260 neurochemical response, 64-65 HIV/AIDS access to care, 205-206 drug abuse effects on course of, 83 drug abuse treatment and, 202, 204-207 economic costs, 163 epidemiology, 161, 164-165 in infants and children, 163 injection drug use as risk factor, 8, 22 medical complications, 204-205 needle exchange programs for risk reduction, 165-166, 255 prevention, 165-166 recommendations for research, 8, 166, 215 research opportunities, 164-166 transmission, 161-163 Hypothalamic-pituitary-adrenal axis, 63 I Illicit drug use extent in general population, 96-102 extent in specific populations, 102-105 terminology, 2-3, 17-18 Immunology, drug vaccination, 39-40, 85 Independent practice association, 224 Individual differences genetic-environmental factors in drug response, 62-64 in response to drugs, 120-121 treatment matching, 207-209 vulnerability to drug use, 48 Initiation of drug use epidemiological data, 109 injection drugs, 166 personality risk factors, 122-123 Injection drug use extent of, 164 HIV/AIDS epidemiology, 164-165 HIV transmission, 8, 22, 161-163 initiation, 166 medical complications of HIV, 204-205 needle exchange programs, 165-166, 255 Interdisciplinary research, 15-16, 29-30 International Classification of Diseases, 10, 18-19, 201 Interpersonal psychotherapy, 196 L Learning theory, 41, 48-49 associative processes, 65-66 Legal issues drug use in pregnancy, 213, 269-270 prohibition of drugs as policy approach, 252-253 Life Skills Training, 141-142 Locus coeruleus, 68-69 Lysergic acid diethylamide, 65, 179, 210 M Magnetic resonance angiography, 81 Magnetic resonance spectroscopy, 72, 81 Managed care access to drug abuse treatment, 231-235 behavioral health care, 223, 227-228 benefit design, 226-227, 231-236 carve-in/carve-out vendors, 223-225, 226-227, 228-229 characteristic features, 223 cost-effectiveness, 239-241 cost of drug abuse treatment, 231-235 cost-shifting, 243-244 delivery systems, 223-225 effectiveness, 237-239 enrollment, 223 financing structure, 225-226 management, 225

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Pathways of Addiction: Opportunities in Drug Abuse Research medical cost offsets, 242-243 obstacles to research, 244-246 outcomes and effectiveness, 222-223, 236-237 public vs. private systems, 228-231 quality of care, 241-242 recommendations for research, 10, 231, 236, 246 selective contracting, 225 utilization of drug abuse treatment, 231-235 Marijuana extent of dependence, 102 maternal use during pregnancy, 166, 171 neurochemical response, 65, 67 predisposing personality traits, 123 regulatory policy, 252, 254-255 trends, 100-101 user perceptions, 109-110 violent behavior associated with, 179 Mass media, 145-146, 151 Medicare, 229 Methadone maintenance, 26, 71, 194, 195 effectiveness, 197 gender differences, 212-213 on-site medical services, 206-207 regulatory policy, 253-254 research needs, 202 N-Methyl-D-aspartate antagonists, 75 Methylenedioxymethamphetamine, 83 Mexican Americans, 125, 126 Midwestern Prevention Project, 141-142 Monitoring the Future Study, 99-101 Monoamine oxidase, 121 Monoclonal antibodies, 40 Motivation for drug use adjunctive behaviors, 43-44 alternative reinforcers, 44-45 appetitive behaviors, 45 deterrent effects of criminal sanctions, 261-266 neurochemical systems in withdrawal, 66-67 priming dose phenomenon, 45 treatment matching criterion, 208-209 Motivational enhancement therapy, 196 N Nalmafene, 195 Naloxone, 70, 195 Naltrexone, 40, 70, 195 National AIDS Demonstration Research Project, 106 National Comorbidity Survey, 101-102 National Cooperative Agreement for AIDS Community Based Outreach Intervention Research Program, 106-107 National Health and Nutrition Examination Survey, 106 National Health Interview Survey of Drug and Alcohol Use, 106 National Household Survey on Drug Abuse, 96-99 National Institute of Justice, 11, 271 National Institute of Mental Health (NIMH), 14 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 10, 14 , 231 National Institute on Drug Abuse (NIDA), 13-14, 31, 74 recommendations for, 10, 11, 231, 271 National Institutes of Health (NIH), 30 National Longitudinal Survey of Youth, 106 Native Americans, 125, 127 Needle exchange programs, 165-166, 255 Neuroscience research accomplishments, 4-5, 15-16, 56-57, 62 brain disease model of addiction, 20-21 individual differences in drug response, 62-64

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Pathways of Addiction: Opportunities in Drug Abuse Research opportunities for enhancement, 78-86 for pharmacotherapies, 16, 203 prospects, 4, 56 recommendations for, 5, 87 research needs, 75-78 Neurotransmitter mechanics, 15-16, 58 alcohol-violence linkage, 178 animal models, 80-81 biomarkers for substance abuse, 121 brain imaging, 71-73, 81-82 dopaminergic system, 37-38, 62, 64-65, 67, 70, 71, 73, 76-77, 79, 82-83, 172 drug agonists, 71 drug antagonists, 70-71 in drug dependence, 61-62 drug-induced adaptations, 75-76 in drug tolerance, 65-66 life span effects of drug exposure, 174-175 long-term effects of drug use, 60, 76-77, 84-85 medial forebrain bundle in, 64 neurotoxic effects of drug use, 83-84 neurotrophic factors, 60-61 nucleus accumbens in, 77 pain pathways, 74-75 pain research, 85-86 prenatal cocaine exposure, 172 protein phosphorylation, 59-60 psychiatric disorder-drug dependence linkages, 82-83 receptor activity, 58-59 in reinforcement process, 64-65, 67 in relapse, 69, 84-85 second messenger systems, 59-60 signal transduction pathways, 80 synaptic transmission, 57-58 in withdrawal, 66-69 See also Neuroscience research Neurotrophins, 60-61 Nicotine/tobacco, 127 agonist therapies, 71 craving response in users, 46 as drug, 2-3, 16-17 economic costs of maternal use during pregnancy, 167 extent of dependence, 102 neurochemical reinforcement, 65 prenatal exposure, 168-169 prevalence of maternal use during pregnancy, 166 regulatory policy, 253 withdrawal, 42-43 youth-oriented antismoking campaigns, 145-146 Nitric acid, 59 Norepinephrine, 66 O Office of Justice Programs, 14 Opiates/opioids addiction treatment options, 194 agonists/antagonists, 40, 70, 195 brain imaging studies, 86 clinical use, 86 definitions, 18 drug interactions, 173 drug-seeking behaviors in withdrawal, 66-67 locus coeruleus model of dependence, 68-69 neurochemical response, 61, 64-65, 67, 68 pain-relieving action, 74-75 pharmacotherapy, 195-196 prenatal exposure, 170-171 receptor sites, 86 violence linkage, 178 Opioid peptide system, 62, 65, 66, 67, 68 Outcome research assessment instruments, 201-202, 239 coerced treatment, 267-268 community-based preventive interventions, 146-147, 151 craving as treatment outcome indicator, 46-47

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Pathways of Addiction: Opportunities in Drug Abuse Research day hospital vs. inpatient treatment, 240-241 drug abuse treatment in corrections system, 214 drug use morbidity/mortality, 106 gender differences, 212-213 managed drug abuse care, 10, 222-223, 236-244 placement criteria as outcome predictor, 242 research needs, 202 treatment efficacy, 197-198 treatment matching, 208, 209 violent behavior in psychiatric drug abuse patients, 180 Oxazepam, 211 P Pain brain imaging studies, 86 clinical indications for opioids, 86 neurobiological research, 4-5, 85-86 neurochemistry, 74-75 significance of drug abuse research, 16, 74-75 Parent-focused preventive interventions, 143-144 PCP. See Phencyclidine Peer relations, 125-126 Personality disorders, 82, 180 Pharmacotherapy antagonists of drugs of abuse, 40, 70-71 antidepressant, 210 drug interactions, 211 implementation of research findings, 28 implications of medical model of dependence, 26-27 integrated with psychosocial treatment, 194 low abuse-potential medications, 38-39 medications development, 203-204 with pregnant women, 213 for psychiatric disorders in drug abusers, 210-211 research accomplishments, 16 Phencyclidine (PCP), 38, 82, 179 Phosphatidylinositol, 59 Positron emission tomography, 72-73 Pregnancy, drug use in confidentiality issues in treatment, 269-270 costs of, 167 criminalization of, 213, 269-270 fetal alcohol exposure, 169-170 fetal cocaine exposure, 171-172 fetal marijuana exposure, 171 fetal nicotine exposure, 168-169 fetal opiate exposure, 170-171 obstacles to quantifying fetal drug exposure effects, 167-168 opportunities for research on fetal exposure, 172-175 paternal drug use, 174 pharmacotherapy for, 213 prevalence, 105, 166 recommendations for research, 176 self-reported data, 173-174 treatment implications, 213 windows of fetal vulnerability, 172-173 Preventive interventions administration of, 153-154 community-based, 146-147, 151 conceptual trends, 139-140 cost-benefit analysis, 149 criminal sanctions, 261-266 evaluation methodology, 143, 153 family-based, 143-145, 149-150 HIV/AIDS, 165-166 indicated, 7, 139 media-based, 145-146, 151. for minority populations, 148, 152-153 primary, 7, 139-140 protective factors enhancement, 127-128 in public health framework, 25 recommendations for, 7

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Pathways of Addiction: Opportunities in Drug Abuse Research recommendations for research, 154 research accomplishments, 15 research needs, 147-151 research opportunities, 152-153 research trends, 6 school-based, 141-143, 147-149, 152 secondary, 7, 139-140 selective, 7, 139 targeted to transition from abuse to dependence, 148, 152 tertiary, 7, 139-140 types of, 7, 139 universal, 7, 139-140 Priming dose phenomenon, 45 Product development, 28 antiaddiction medications, 203-204 behavioral models in new drug development, 38-41 Protective factors for alcoholism, 121 defined, 6, 118 familial, 143 protective-protective, 118 research opportunities, 127-128 risk-protective, 118 Psychedelic drugs. See Hallucinogens Psychiatric disorders benefits of drug abuse research, 16 drug dependence-associated, 82-83, 124 drug-induced, 210 gender differences, 212 psychotic disorders, 82 as risk factor for drug abuse, 123 Psychiatric disorders with co-occurring drug abuse, 101-102, 107-108, 123-124 assessment and diagnosis, 210 in parents, 175 pharmacotherapy, 210-211 research recommendations, 182 treatment, 9, 209-211 violent behavior associated with, 180-182 Psychotherapy, 196-197 Public perceptions of addiction, 20-21 drug research funding and, 25 on effects of drug-taking, 109-110 political context of research, 28 Q Quality of care, in managed drug abuse care, 241-242 R Race/ethnicity, 99, 110 physiological differences in drug response, 99, 110, 120-121 preventive intervention design, 148, 152-153 risk factors, 125, 126-127 youth drug use, 128 Reinforcement contingency contracting therapy, 196-197 individual differences, 63 neural substrate, 64-65, 67 via antagonists of drugs of abuse, 70-71 Relapse after prolonged abstinence, 84-85 animal models, 69 behavioral research in prevention, 42 drug antagonist therapies, 70-71 in medical model of addiction, 20 naltrexone effects, 195 neurobiological substrate, 69, 84-85 priming dose phenomenon, 45 probability, 19-20 Research in drug use achievements of, 14-16 benefits of, 1, 22 cross-disciplinary benefits, 15-16, 29-30 funding, 1, 13-14, 24-25, 31 goals, 1, 21, 30-31 historical development, 13, 284-292 implementation of findings, 27-28

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Pathways of Addiction: Opportunities in Drug Abuse Research implications of medical model of dependence, 26-27 obstacles to interdisciplinary collaboration, 29-30 opportunities for enhancing, 22-24 as percentage of federal spending on drug control, 15-16 political context, 28 professional development, 28-29 in public health framework, 25-26 spending, 2, 14, 22 Risk factors behavioral research on, 48-49 defined, 6, 117 familial, 124-125, 129, 143-144 genetic, 119120 HIV, 8, 165 peer, 125-126 personality traits, 122-123 psychopathology, 123-124 research opportunities, 128-130 sociocultural, 126-127 violent behavior, in psychiatric drug abusers, 181 S Schizophrenia, 82, 181 School-based prevention programs, 141-143, 147-149, 152 Self-reported data, 112-113 maternal drug use, 173-174 Serotonergic system, 66, 67 Sexuality/sexual behavior drug effects on male reproductive system, 174 HIV transmission, 162-163 Single-photon emission computed tomography, 72 Social norms, 109-110 risk factors, 126-127 Stages of drug-taking behavior, 3, 18 epidemiologic data, 108-109 targeting of preventive interventions, 7, 139 treatment matching criteria, 208-209 Stress, drug-taking response to, 63 Substance Abuse and Mental Health Services Administration, 10, 14, 106, 231 Supportive-expressive psychotherapy, 196 Survey of Health Related Behaviors Among Military Personnel, 104-105 T Technology transfer, 27-28 Tetrahydrocannabinol (THC). See Marijuana Tobacco. See Nicotine/tobacco Tolerance clinical features, 19 in etiology of alcoholism, 121 neural substrate, 65-66 Treatment access, 193, 205-206, 212, 213, 231-235 assessment and diagnosis, 200-202 behavioral conditioning, 41-42 chemical dependency programs, 194 for children and adolescents, 214-215, 270 for co-occurring psychiatric disorders in drug abusers, 9, 209-211 confidentiality issues, 268-270 in correctional settings, 213-214 cost-benefit analysis, 198-200 cost-shifting, 243-244 costs of managed drug abuse care, 167 of drug-abusing women, 212-213 drug immunizations, 39-40, 85 drug users with HIV, 204-207 duration, 197, 202, 233 effectiveness, 9, 197-198 effectiveness of managed care, 237-239 HIV risk reduction in, 165

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Pathways of Addiction: Opportunities in Drug Abuse Research indications for, 192-193 integrated psychosocial-pharmacologic, 194 legally coerced, 266-268 in managed care systems, 10, 222, 225, 227-228, 231-236 medical cost offsets, 242-243 medications for, 39-41, 70-71 modalities, 9 options, 194 outpatient, 194 patient compliance, 198 placement criteria, 242 of pregnant women, 213, 269-270 primary medical care in drug abuse programs, 205-207 psychosocial, 196-197 public vs. private settings, 228-231 recommendations for research, 9-10, 215 research accomplishments, 15, 192, 193 research opportunities, 202 significance of craving, 46-47 significance of motivational research, 43-45 special populations, 211-212 in therapeutic communities, 194 treatment matching, 207-209 utilization, 193 vs. drug control strategies, 199-200 vs. punishment, 256-257 See also Pharmacotherapy Treatment Alternatives to Street Crime (TASC), 214, 266-267 Treatment Outcome Prospective Study, 197-198 Treatment Services Review, 202 Twelve-step programs, 194 U Urinalysis, 113 Utilization of treatment resources, 193 confidentiality and, 268-270 managed care systems, 231-235 medical cost offsets, 242-243 V Violence/violent behavior alcohol linkages, 177-178 behavioral research, 47-48 cocaine linkages, 178-179 co-occurring psychiatric disorders and drug abuse, 180-182 drug abuse linkages, 176 in drug-related crimes, 176-177, 178 in drug trade, 176 drug use linkages, 8-9 opiate linkages, 178 as pharmacological effect of drugs, 177-180 as predictor of alcoholism, 122 research recommendations, 9, 182 Vulnerability to drug use, 48-49 Genetic basis, 75, 78, 119-120 Individual differences, 120-121 W Withdrawal, 19, 37 behavioral research, 42-43 conditioned, 42 determinants of drug-seeking behavior in, 66-67 drug antagonist therapies, 70-71 hypothalamic system in, 67 locus coeruleus model, 68-69 negative affective states in, 67 neurochemical substrate, 66-69 in newborns, 170 physical signs, 66-67 psychological signs, 66 Y Youth Risk Behavior Surveillance System, 106