Kantian Perspectives on Drug Use and Drug Criminalization

Ethnic differences in the effect of drug use and drug dependence on brief motivational interventions targeting alcohol use

Integration of Psychodynamic and Cognitive-Behavioral Approaches Historically, psychotherapeutic approaches utilized with substance abusers have been a reflection of the most prominent modality being used at that particular time to treat mental disorders. Initially, the principles of psychoanalysis and psychodynamic psychotherapies were applied to substance abusers (1, 2). The concept that all symptoms arose from some underlying and often unconscious psychological conflicts was applied to the symptoms of drug abuse (3). Without resolution of the underlying conflict, symptom substitution would occur, e.g., depression or phobias. Unfortunately, using psychoanalysis or psychodynamic psychotherapy as the only treatment modality yielded disappointing outcomes. The therapist's typically neutral, passive stance that is essential to the development of transference and exploration would be ineffective in controlling the active symptoms of drug abuse. The lack of structure and limit setting allowed the ongoing drug use to undermine the treatment. The anxiety-arousing aspect of free association would elicit more drug use. Patients dropped out of treatment. Perhaps in response to the failure of psychodynamic therapies, other psychosocial treatments, geared specifically to substance abusers, were developed. These include Alcoholics Anonymous (AA) and therapeutic communities. Subsequently, the principles of cognitive, behavioral, and client-centered therapies began to be modified for application to addicted patients (4, 5). In addition, biological treatments, such as methadone maintenance for opiate dependence (6) and disulfiram for alcohol abuse (7), were introduced. The prevailing strategy that is now central to all psychotherapeutic modalities is to primarily focus on the achievement of abstinence from drug use. Once drug use becomes controlled and abstinence is attained, then the recovering addict can begin to address issues of social rehabilitation, interpersonal functioning, and even resolution of intrapsychic conflicts. There is growing evidence that individual psychotherapy can be an effective modality for substance abusers (8). The key is to match the appropriate modality to the patients' needs, depending on their stage of recovery. The sequence and timing of psychotherapeutic modalities ranging from cognitivebehavioral therapies to the integration of psychodynamic principles enhance the possibility of successful outcomes. The following is a brief description of how the various psychotherapeutic approaches can be integrated into the treatment of substance abusers. Multiple factors may influence what brings a drug abuser into treatment. But rarely is the initial motivation a desire to stop drug use altogether. Typically, the motivating factors are externally driven. These can include legal consequences of drug or alcohol use (e.g., DWI), marital or family difficulties, and school or employment jeopardy, as well as physical consequences of drug use (e.g., hepatitis, cirrhosis, HIV disease, etc.). The general motivation is that if these external consequences could be alleviated, then the substance use would not be seen as a problem. Women tend to enter treatment via the mental health or primary care system with psychological complaints of depression and anxiety and only on further questioning does it become clear that there is comorbid drug or alcohol use (9). Certain investigators have hypothesized stages in the development of drug abusers' readiness to stop drug use (10, 11). These range from precontemplation to contemplation and on to action and determination. These motivational approaches hinge on meeting patients where they are at. In order to build the resolve to stop, the ego-syntonic aspects of drug use (e.g., pleasure, social gratification, relief of painful affects) need to be counterbalanced by the ego-dystonic aspects of drug use (e.g., medical sequelae, loss of job, divorce). This motivational form of therapy uses cognitive principles to help set the goals and framework for the psychotherapy. …

Recent studies investigating the labor-market effects of illicit drug use have consistently found a positive relation between drug use and earnings. These analyses have, however, ignored the potential relationship between drug use and human-capital formation. This paper examines the effect of drug use during adolescence on formal educational attainment using a sample drawn from the National Longitudinal Survey Youth Cohort. The probability of drug use is estimated across racial groups according to three categories; use of any illicit drug, use including hard drugs, and use of only marijuana. Fitted values for the probability of drug use are calculated and entered into a regression framework to estimate the number of school years completed. The empirical results indicate that all three categories of drug use are associated with significant negative impacts on educational attainment after controlling for individual differences in personal endowments and socioeconomic characteristics. On average, adolescent drug use is found to reduce eventual educational attainment by about 1 year, ceteris paribus . These findings suggest that previous studies that focus only on the direct effects of drug use on earnings may reflect a statistical bias that leads to an overstatement of the positive effects of drug use on earnings.

Prevention of adolescent chemical dependency

Prevention of Adolescent Chemical Dependency

The concept of prevention was first developed in the field of public health and epidemiology. Since the 1960s, it has been applied increasingly to illicit drug use, thus standing alongside law and treatment as a major form of social control over drugs. While a strict epidemiologic, or "contagion," model of drug use is held by some, we find this model to be of limited utility for discussing the broad range of efforts commonly defined in the field as preventive. An economic, or supply-demand, model is proposed instead. Under this model, prevention is defined as the attempt to reduce the demand for drugs. Four strategies for reducing demand are discussed: (1) coercion, or the threat of formal punitive sanctions; (2) persuasion, or education in the harmful consequences of drug use; (3) correction, or the eradication of the presumed causes of drug use; and (4) substitution, or the provision of alternatives to drug use. The limitations of each strategy are discussed, and because of the prevalence of recreational patterns of moderate drug use, it is concluded that the prevention of all illicit drug use is not an achievable goal.

Clinical trials and clinical studies, using patented drugs and drugs off patent, provide data that impact the best treatment practices for substance abuse and dependence. In the United States, medications have been approved for use in the treatment of both alcohol and opioid dependence. Medications are used in the detoxification from drug abuse and dependence in the symptomatic relief of withdrawal. For long term treatment or medical maintenance treatment, medications eliminate the physiological effects of drug use by blocking drug-receptor binding in the brain. Therefore, patented drugs showing interactions with neurotransmitters in the brain, are attractive candidates for treatment efficacy trials. An effective long term treatment paradigm for reducing drug dependence is the combinatorial use of medications that block the effects of drug use with behavior change counseling and psychotherapy. Medications used for the long term treatment of opioid dependence are methadone, buprenorphine, and naltrexone. Pharmacotherapies used in the treatment of alcohol dependence include acamprosate, antabuse and naltrexone. A reliable indicator for successful treatment of drug dependence is time in treatment. Patients remain in long term treatment when they perceive that their health care environment is supportive and non-stigmatizing and with a good patient-provider relationship where their needs are identified and met. Additional medications are needed for individual comprehensive substance abuse treatment plans, particularly for individuals who abuse stimulants. Patented drugs remain an important source of candidate pharmacotherapies comprising medication assistant treatment, part of a comprehensive treatment plan for drug dependence that addresses the medical, social, and psychological needs of the patient. Adapting this drug treatment paradigm globally requires identifying and testing new drug candidates while building and changing programs to patient centered treatment programs that promote access to care and treatment and integrate medical, psychological, and social services.

Effects of early adolescent drug use on cognitive efficacy in early-late adolescence: a developmental structural model.

This chapter focuses on the etiology and consequences of drug use from an interactional perspective. In the first part of the chapter, the interrelation of risk and protective factors as they affect adolescent drug use is discussed. Next, the childhood factors relating to adolescent drug use are discussed. The third part of the chapter addresses issues pertaining to the consequences of drug use. The chapter highlights recent advances in these areas and promising extensions in current research, prevention, and treatment.

The reliability and validity of interview data obtained from 59 narcotic drug addicts.

Peer support, perceptions of adverse effects, and the hallucinogenic drug experience

OBJECTIVES: This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18–22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously. METHODS: Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health. RESULTS: Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling. CONCLUSIONS: College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.

Sustained abstinence is currently the only accepted end-point for pharmacotherapy trials for most substance use disorders (SUD), with the exception of alcohol. Despite recent efforts, the identification of a non-abstinence alternative as a clinically meaningful end-point for drug use trials has been elusive. The current standard for establishing a clinically meaningful outcome in SUD trials is to demonstrate that a reduction in drug use is associated with improvement in long-term functioning, but data indicate relatively weak associations between drug use and various psychosocial problem domains. This may be because assessments used most commonly to measure an individual's functioning do not specify whether aspects of functioning are a direct consequence of drug use. The acceptance of a non-abstinence-based end-point for alcohol use disorder trials was supported in part through associations with reductions in alcohol-related consequences, although measures designed to assess the direct consequences of drug use are rarely included in drug treatment efficacy trials. The field of substance use disorders should include measures of negative psychosocial and health consequences of drug use, as opposed to overall functioning, in the effort to establish meaningful non-abstinence-based end-points.

Ross, Amanda; Raab, Gillian M.; Mok, Jacqueline; Gilkison, Sara; Hamilton, Barbara; Johnstone, Frank D. Author Information

To determine the separate effects of maternal HIV infection and drug use during pregnancy on growth of uninfected children in their first 3 years. Retrospective analysis of measurements from health visitor records made during routine child health surveillance at 6 weeks, 10 months, and 3 years of age. Multilevel analysis allowed for between-infant variation in fitted growth lines, and adjustment for other factors. Growth was described in terms of an intercept (z score at term) and growth slopes (change in z score per year) up to, and from, 4 months. 290 case babies delivered in Edinburgh hospitals to women who reported injection drug use by either themselves or their HIV infected partner, and 186 community controls. A total of 131 (45%) of the case babies were born to women who used drugs, predominantly opiates, during pregnancy and 93 (32%) to HIV infected women. The eight infected children were excluded from analysis. Age and sex standardised z scores for height, weight, and body mass index. 459 (96%) of the 476 records for cases and controls were traced, yielding 1432 weight and 939 height measurements. Maternal HIV infection was not found to affect growth; at 3 years the estimated effect on weight z score was 0.16 with 95% confidence interval (-0.25 to 0.57) and for height 0.18 (-0.19 to 0.55). Drug use during pregnancy was associated with lighter babies at 40 weeks followed by depressed growth in the first four months, these infants remaining just slightly smaller at 3 years with an estimated effect on z scores of -0.5 for weight with 95% confidence interval (-0.89 to -0.11) and -0.37 (-0.72 to -0.02) for height. Maternal HIV infection does not adversely affect growth in uninfected infants, and the effect of drug use during pregnancy is limited to small decrease in size at 3 years.