Index

A

Academic Career Award, 108

Academic Centers of Excellence, 6, 8, 135

Acamprosate, 81, 200

Access to substances, 62-63, 65-66

Accreditation and certification, 5, 106, 111

Acetylcholine, 40

Addiction

behavioral effects, 45

costs, 2, 11, 25-28

definition, 1, 13-14

multifactorial model, 13, 37-39, 48, 162

neurobiology of transition to, 42-46

patterns of early substance use, 19-20

risk factors, 47-49

Addiction Severity Index, 76

Adenosine metabolism, 172-173

Advertising bans, 58-60

Advocacy and consumer groups, 208-209

competition among, 141-142

for needs of addicted persons, 141-142

recommendations for, 9, 146

role of, 144-146

Age variation

alcohol use, 22

alcohol use, risk of, 47

illicit drug use patterns, 20

nicotine use, 22

rationale for early intervention, 19

substance use trends, 25

Agency for Health Care Policy and Research, 8, 134

Alcohol use/abuse

access effects, 62

advertising bans, 58-60

age at onset, 47

aversive reaction, 47

costs, 2

demographic patterns, 22-23

detoxification, 74

fetal alcohol syndrome, 58

as gateway drug, 22

genetic risk factors, 47-48, 174-176

legal restrictions, 65-66

media portrayals, 65

neurochemistry, 40, 41, 45, 169, 171-176

pharmacotherapy, 81

prevalence, 21-22, 170

price effects, 61

psychosocial interventions, 79, 80

recent research advances, 195, 196-197, 199, 202-203

related morbidity/mortality, 22

server role, 62

social costs, 25, 27

tolerance, 170-171

treatment effectiveness, 73



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Index A Academic Career Award, 108 Academic Centers of Excellence, 6, 8, 135 Acamprosate, 81, 200 Access to substances, 62-63, 65-66 Accreditation and certification, 5, 106, 111 Acetylcholine, 40 Addiction behavioral effects, 45 costs, 2, 11, 25-28 definition, 1, 13-14 multifactorial model, 13, 37-39, 48, 162 neurobiology of transition to, 42-46 patterns of early substance use, 19-20 risk factors, 47-49 Addiction Severity Index, 76 Adenosine metabolism, 172-173 Advertising bans, 58-60 Advocacy and consumer groups, 208-209 competition among, 141-142 for needs of addicted persons, 141-142 recommendations for, 9, 146 role of, 144-146 Age variation alcohol use, 22 alcohol use, risk of, 47 illicit drug use patterns, 20 nicotine use, 22 rationale for early intervention, 19 substance use trends, 25 Agency for Health Care Policy and Research, 8, 134 Alcohol use/abuse access effects, 62 advertising bans, 58-60 age at onset, 47 aversive reaction, 47 costs, 2 demographic patterns, 22-23 detoxification, 74 fetal alcohol syndrome, 58 as gateway drug, 22 genetic risk factors, 47-48, 174-176 legal restrictions, 65-66 media portrayals, 65 neurochemistry, 40, 41, 45, 169, 171-176 pharmacotherapy, 81 prevalence, 21-22, 170 price effects, 61 psychosocial interventions, 79, 80 recent research advances, 195, 196-197, 199, 202-203 related morbidity/mortality, 22 server role, 62 social costs, 25, 27 tolerance, 170-171 treatment effectiveness, 73

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treatment matching, 82 treatment setting, 75-78 use trends, 24, 25 warning labels, 57-58 withdrawal effects, 171-172 Alcoholics Anonymous, 76-77 American Association for the Advancement of Science, 97 Amphetamine neurobiology, 41 Animal studies, 39 alcohol addiction risk, 47-48 recent research, 195-197 relapse processes, 165-166 research needs, 164 Antabuse®, 79, 81 Antisocial personality, 57 Anxiety disorder, 57 Assessment and diagnosis addiction severity measures, 76 in primary care settings, 63 treatment setting decisions, 76 Attention deficit disorder, 57 Attitudes and beliefs moralistic view of addiction, 139-140 as risk/protective factors, 3, 55-56 B B/START, 7, 132 Behavioral sciences, 134, 201-203 Behavioral therapies, 79, 80 Board certification/examination, 5, 101, 104, 106, 110 Brief therapy, 79 Buprenorphine, 85, 200 C Calcium channel regulation, 171-172 Career development awards, 7, 116, 120, 132 Career Teacher Training Program, 6, 108, 109, 120 Causes of addiction conceptual model, 1, 9-10 n.1 See also Initiation Center for Substance Abuse Prevention, 30 Center for Substance Abuse Treatment, 30 Chemical dependency programs, 77 Clinical practice guidelines, 76, 79 Cocaine use/abuse crack/free base, 44-45 demographic patterns, 19 neurobiology of, 40, 41, 44-45, 49 pharmacotherapy, 81-82, 164-165 psychosocial interventions, 80 treatment effectiveness, 73 treatment matching, 82-83 treatment settings, 75-78 Community reinforcement, 79 Conduct disorder, 57 Costs, 16 disease comparison, 28, 30 of drug abuse and addiction, 2, 11, 25-28, 30, 32 health care, 2, 19 indirect/related, 25 morbidity/mortality, 27 of treatment vs. interdiction, 32 of undiagnosed addictive disorders, 63 Credentialing and licensing, recommendations for, 6, 106, 111 Criminal justice funding, 30, 33 Cues, behavioral, 46, 56, 165-166 D D.A.R.E., 64 Delivery mechanisms, 44-45 nicotine gums and patches, 86-87 Dependence definition, 13, 14 neurobiology, 46 Depression, 57, 141-142 in cocaine addiction, 83 Desipramine, 80 Detoxification, 74 in opioid addiction treatment, 83 Diagnostic and Statistical Manual of Mental Disorders-IV, 15 Disease model, 1, 9-10 n.1, 13, 37-38 pediatric onset, 19 personal agency and, 48 public education, 144 vs. moralistic view of addiction, 139-140 Disulfiram, 79, 81

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Dopaminergic system adaptive emotional circuit, 43-44, 46 brain reward system, 39, 40-41, 164 drug effects, 40, 41 recent research advances, 193 significance of, in addiction processes, 2, 37, 49 Drug classification by neurobiological effects, 45 opioids, 10 n.2 rationale, 15 stimulants, 10 n.2 typologies, 15, 162 E Education and training in addiction studies, 16 funding for researchers, 121, 132-133 in medical schools, 5, 100-101, 103-104 multidisciplinary approach, 104 obstacles to research careers, 95, 96-97, 115, 133-134, 206 recommendations, 4-7, 97-98, 111, 132-133 role of mentors, 5-6, 106-109 secondary school level, 4, 97 for treatment professionals, 6, 109-111 Educational attainment, 21 alcohol use, 23 nicotine use, 24 Electroacupuncture analgesia, 166 Elementary schools, 4, 97 Emotional processes, in neurobiology of addiction, 42-44, 46 Employment status, 21 Endorphins, 40 Environmental risk factors, 48, 56 Ethnicity alcohol use, 22-23 nicotine use, 23, 25 prevalence patterns, 21 psychosocial risk factors, 56 F Faculty expertise in substance abuse studies, 100, 101 recruiting, for addiction research, 5, 106 Faculty for Undergraduate Neuroscience, 97 Families advocacy role, 145 preventive interventions in, 65 risk factor for drug use, 56 Fellowship awards, 116, 120 Fetal exposure to alcohol, 58 to nicotine, 164 research needs, 164 First Independent Research Support and Transition, 120 Follow-up care, 74 Foundation awards, 131 Funding, 16 characteristics of individual awards, 116 for clinical investigators, 8, 133-134 federal, 30-33, 116, 118, 119-121 for interdisciplinary research, 8-9, 134-136 obstacles to research careers, 16, 115, 207 private sector, 32, 131 recommendations, 6, 7-9, 132-133, 134 system problems, 118 trends, 119-120, 121 vulnerable junctures in research careers, 120-121 G GABA, 40, 81, 195 Gamma-hydroxybutyric acid, 81, 200 Gender differences, 21 alcohol use, 23 nicotine use, 23-24 Gene knockout research, 164, 193 Genetic predisposition, 47-48, 164, 174-176 Geographic variation, 21 alcohol use, 23 nicotine use, 24 Graduate education, 5, 111 opportunities for abuse studies, 99-100

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Grant funding mechanisms, 116 system problems, 121 H Harvard Medical School, 101 Health consequences of addiction, 30 costs, 2, 19 Health Research and Services Administration, 8, 134 Heroin detoxification, 74 High school, 19, 20 I Illegal drugs alcohol use and, 22 costs of addiction, 2, 11 prevalence of use, 20-21 social costs, 25, 27 terminology, 161-162 use trends, 24-25 Individual differences beliefs and attitudes, 3 initiation of drug use, 162-163 Initiation age patterns, 19 alcohol use risk factors, age-related, 47 drug delivery systems, 45 individual differences, 162-163 peer influences, 56 psychosocial factors, 2-3 research issues, 55, 163-165 Insurance, 3 Interdiction, 32, 33 L LAAM, 85, 200 Law enforcement, 32 Life Skills Training, 64 M Media-based interventions, 65 Medical schools education and training in addiction studies, 5, 100-101, 103-104 recommendations, 5, 106 Memory addiction process, 46 neurobiology, 42 Mentors/mentoring recommendations for, 6, 109 role of, 5-6, 106-107, 111 strategies for enhancing, 108-109, 206-207 Methadone, 83, 84, 200 advocates for services, 141 detoxification role, 74 Midwestern Project, 64 Minnesota model of alcoholism treatment, 77 Morbidity, 11 Mortality, alcohol-related, 22 Motivation moralistic view of addiction, 140 to use drugs, 45 N Nalmefene, 49 Naloxone, 85 Naltrexone, 49, 81, 84, 164, 166, 200 National Alliance of Methadone Advocates, 141 National Cancer Institute, 118, 119 National Heart, Lung, and Blood Institute, 118, 121 National Institute of Mental Health recommendations for, 7-8 research funding, 118 National Institute on Alcohol Abuse and Alcoholism recommendations for, 6, 109, 132-133, 136 research funding, 116, 118, 119-120, 121 spending, 30 National Institute on Drug Abuse recommendations for, 6, 7-8, 109, 132-133, 136 research budget, 30, 116, 118, 119-120, 121 National Institutes of Health recommendations for, 8, 132, 134, 135 research funding, 116, 119, 121

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National Research Service Awards, 116, 120, 121 Neurobiology, 2, 16 of alcohol effects, 40, 41, 45, 169, 171-176 current conceptualization of addiction, 37-39, 49 drug delivery systems and, 44-45 drug effects, 41, 44-46, 49, 162-163 drug-induced changes, 45-46 emotional circuitry, 42-44 model of addiction, 48 public education, 144 recent research advances, 193-194, 195-196 of relapse, 165-166 research questions, 49-50 reward pathways, 39-41, 45-46, 164 second messenger system, 40 transition to addiction, 42-46 vulnerability to addiction, 47 New York City, 28 NIAAA. See National Institute on Alcohol Abuse and Alcoholism Nicotine use/abuse access effects, 62-63, 66 advertising bans, 58-59 cessation programs, 85-86 demographic variation, 23-24 economic costs, 2 gums and patches, 86-87 intrauterine exposure, 164 legal restrictions, 65, 66 media portrayals, 65 neurobiology, 40, 41, 49 place-specific prohibitions, 60-61 prevalence, 23 price effects, 61-62 recent research advances, 194, 196, 199, 202 social costs, 25, 27 treatment effectiveness, 73 use trends, 24, 25 warning labels, 58 NIDA. See National Institute on Drug Abuse Norepinephrine, 40 North Carolina Governor's Institute on Alcohol and Substance Abuse, Inc., 104 O Opioids addiction and relapse research issues, 166 detoxification, 83 methadone treatment for addiction, 83, 84 neurobiology, 40, 41, 44, 45, 49 recent research advances, 194, 196, 199 substances classed as, 10 n.2, 15 n.3 treatment strategies, 83 Orlaam®, 85, 200 P Parkinson's disease, 2 Patient-treatment matching, 4, 82-83 Peer relations, 56 preventive interventions based on, 64 Personality trait risk factors, 56 Pharmacotherapy cocaine use, 81-82, 164-165 education, substance abuse studies in, 100 opioid addiction, 83, 84-85 with psychosocial intervention, 80 recent research advances, 199-200 research challenges, 87 role of, 81 treatment matching, 82 Ph.D. programs, 133 recommendations for, 6, 109 Phoenix House, 78 Polysubstance abuse, 15 Posttraumatic stress disorder, 46 Pregnancy, 57-58, 164 Prevalence age patterns, 20 alcohol use/abuse, 21-22, 170 ethnicity patterns, 21 trends, 20-21 of use by drug type, 15

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Preventive interventions advertising restrictions, 58-60 family-based, 65 federal funding, 30, 32-33 indicated, 3, 57 law-based, 65-66 media-based, 65 no-smoking areas, 60-61 peer-based, 64 price controls, 61-62 in primary care settings, 63 private spending, 32 psychosocial factors, 2-3 rationale for early intervention, 10-20, 163-164 restricting access for children, 62-63 in schools, 63-64 selective, 3, 57 target types, 3 universal, 3, 57 warning labels, 57-58 See also Relapse prevention Primary care medicine, 63 education in substance abuse issues, 103-104, 110 nicotine cessation interventions, 85-86 recommendations for education and training, 8, 134 Private sector recommendations for, 7, 132 research careers in, 131 spending, 32 Professional societies board certification/continuing education in abuse specialties, 5, 110-111 recommendations for, 4-5, 98 Protective factors, 3 Protein kinases, 171-172, 173-174 Psychosocial functioning alcohol server interactions, 62 co-occuring psychiatric disorders and substance use, 56-57 effects of advertising, 58-60 initiation of drug use, 2-3 peer relations, 56 personality traits as risk factors, 56 psychiatric/psychological practice specialization, 110 research challenges, 66 research issues, 55 treatment strategies, 79-80 Psychotropic drugs, 14 Public awareness and education, 16, 208 advertising bans, 58-60 advocacy for addiction services, 141-142, 208-209 barriers to research, 142 content, 9 importance of, for research efforts, 9, 139 media-based interventions, 65 moralistic view of addiction, 139-140 recommendations for, 9, 144 school-based interventions, 63-64 selective preventive interventions, 3, 57 trends in substance use and, 24 universal preventive interventions, 3, 57 warning labels, 57-58 R Rehabilitation, 74 Reimbursement issues, 3 Relapse prevention, 74 opioid addiction treatment, 84 psychosocial interventions, 80 research issues, 165-166 Research career pathways, 96, 115 clinical, 8, 133-134 collaborative interdisciplinary, 8-9, 134-136, 167, 205-206 competition among researchers, 131-132 federal funding, 30, 33, 116, 118, 119-121 funding trends, 119-120, 121 historical development, 178-192 in initiation processes, 163-165 issues in addiction, 11-12 mentors, 5-6, 106-109, 206-207 obstacles to career development, 16, 95, 115, 133-134, 206, 207

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opportunities in neurobiology, 49-50, 167 private sector, 131 psychosocial, challenges in, 66 public awareness/support, 9, 139, 142 rationale, 28-30 recent advances in behavioral sciences, 201-203 recent advances in neurochemistry, 193-197 recent advances in pharmacotherapy, 199-200 recommendations for education and training, 5-7, 106, 132-133 recommendations for funding, 6-9, 132, 133, 134 in relapse processes, 165-166 role models, 97, 107 shortcomings in education and training for, 95, 96-97, 206-207 social stigma as obstacle to, 140 treatment issues, 4, 87, 109-110, 165 vulnerable junctures in career development, 120-121 Risk of abuse/addiction access, 62 current understanding, 47 environmental factors, 48 genetic predisposition, 47-48, 174-176 Robert Wood Johnson Foundation, 131 S SAMHSA. See Substance Abuse and Mental Health Services Administration Schools, public education campaigns in, 144 Secondary schools addiction curricula, 97 recommendations for, 4, 97-98 Self-control training, 79 Self-esteem, 64 Self-medication, 56-57 Senior Scientist Award, 108 Serotonergic system, 40, 44 Smoking. See Nicotine use/abuse Social skills training, 80 Stimulants recent research advances, 194, 196, 199, 202 substances classed as, 10 n.2, 15 n.3 Stress and coping, 80 Substance Abuse and Mental Health Services Administration programs, 30-32 purpose, 30 recommendations for, 8, 134 Support groups, 74 T Therapeutic communities, 77-78 Tolerance to alcohol effects, 170-171 definition, 13 neurobiology, 45-46 Treatment, 16 cue-dependent memory, 46, 56 detoxification, 74 effectiveness, 3-4, 32, 73-74, 79, 87 federal funding, 30, 32-33 follow-up, 74 historical development, 178-192 implications of model of addiction, 2, 48-49, 50, 75 length of, 76 nicotine cessation programs, 85-87 opioid addiction, 83-85 outcome determinants, 4, 74, 75 patient-treatment matching, 4, 82-83 pharmacotherapy, 80, 81-82 private spending, 32 psychosocial, 79-80 recent advances in behavioral sciences research, 201-203 recent advances in pharmacotherapy research, 199-200 recommendations for professional education and certification, 6, 109-111 rehabilitation stage, 74 relapse prevention, 74, 80 research issues, 4, 87, 109-110, 165 settings, 75-78 social stigma as obstacle to, 140 stages of, 74

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support groups, 74 variation in services, 4, 74-75 U Undergraduate education, 4-5, 98 University of Pennsylvania Medical School, 101 Use definition, 13 n.1 neurobiology of transition to addiction, 42-46 W Warning labels, 57-58 White House Office of National Drug Control Policy, 9, 136 Withdrawal, 45 alcohol, 171-172 opioid, 83, 85 Workplace costs of substance abuse, 11 World Health Organization, 15