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« Previous: Appendix C: Diagnostic Criteria
Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

Suggested Citation:"Index." Institute of Medicine. 1996. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington, DC: The National Academies Press. doi: 10.17226/5297.
×

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

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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 relevance--to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

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