Nonmedical Drug Use Research Articles

Prescription opioid use among university students: Assessment of post-cue exposure craving

Despite the increasing number of prescriptions written to adolescents and young adults for opioid analgesics, the rise in non-medical use of such drugs among university students, and the potential role of craving in the misuse of opioids, there have been no published studies assessing craving for prescription opioids in this population. Therefore, the current study was designed to assess the impact of prescription opioid-related cue exposure on craving in university students. Students (n=277) recruited from a large university in the Midwestern United States were randomly assigned to two conditions to test the impact of cue exposure to either prescription opioid-related stimuli or control stimuli. Relative to the control condition, prescription opioid-related cue exposure significantly increased overall craving, desire and intention to use prescription opioids, relief from negative states by using prescription opioids, and perceived control over prescription opioid use. In addition, when assessing correlates of post-cue exposure craving, negative mood and procurement of prescription opioids from non-medical sources were the only measured variables that were significantly associated with overall craving and/or any of the craving measure's subscales. Craving may be important aspect of prescription opioid use among university students. Future research assessing craving as a function of non-medical user subtype is warranted.

Illicit and nonmedical drug use among Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race individuals

BackgroundThe racial/ethnic composition of the United States is shifting rapidly, with non-Hispanic Asian-Americans, Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race individuals the fastest growing segments of the population. We determined new drug use estimates for these rising groups. Prevalences among Whites were included as a comparison. MethodsData were from the 2005–2011 National Surveys on Drug Use and Health. Substance use among respondents aged ≥12 years was assessed by computer-assisted self-interviewing methods. Respondents’ self-reported race/ethnicity, age, gender, household income, government assistance, county type, residential stability, major depressive episode, history of being arrested, tobacco use, and alcohol use were examined as correlates. We stratified the analysis by race/ethnicity and used logistic regression to estimate odds of drug use. ResultsPrevalence of past-year marijuana use among Whites increased from 10.7% in 2005 to 11.6–11.8% in 2009–2011 (P<0.05). There were no significant yearly changes in drug use prevalences among Asian-Americans, NHs/PIs, and mixed-race people; but use of any drug, especially marijuana, was prevalent among NHs/PIs and mixed-race people (21.2% and 23.3%, respectively, in 2011). Compared with Asian-Americans, NHs/PIs had higher odds of marijuana use, and mixed-race individuals had higher odds of using marijuana, cocaine, hallucinogens, stimulants, sedatives, and tranquilizers. Compared with Whites, mixed-race individuals had greater odds of any drug use, mainly marijuana, and NHs/PIs resembled Whites in odds of any drug use. ConclusionsFindings reveal alarmingly prevalent drug use among NHs/PIs and mixed-race people. Research on drug use is needed in these rising populations to inform prevention and treatment efforts.

Adult Nonmedical Prescription Drug Use: An Examination of Bond Theory

Using data from the 2010 National Survey of Drug Use and Health (NSDUH), this research examines the extent to which social bonds predict nonmedical prescription drug use among adults. Logistic regression analyses reveal that marital bonds are consistently and negatively related to various types of nonmedical drug use net other social and medical factors; however, employment bonds are only significant and negative in models predicting nonmedical pain reliever use. Analyses of interaction terms between gender and social bonds are examined but are found non-predictive. Issues concerning a lack of data availability for adult nonmedical drug use and the quality of adult bonds are discussed.

Novel Drugs of Abuse: A Snapshot of an Evolving Marketplace.

Over the past decade, non-medical use of novel drugs has proliferated worldwide. In most cases these are synthetic drugs first synthesized in academic or pharmaceutical laboratories for research or drug development purposes, but also include naturally occurring substances that do not fit the typical pharmacological or behavioral profile of traditional illicit substances. Perhaps most unique to this generation of new drugs is that they are being sold over the counter and on the Internet as "legal highs" or substitutes for traditional illicit drugs such as cannabis, cocaine, amphetamines, MDMA, and LSD. The purpose of this review is to provide an overview of novel drugs in current use, including the epidemiology of use and toxicologic and pharmacological properties, and to offer some guidelines to clinicians who see patients experiencing adverse effects from these drugs. We review the known scientific literature on recently introduced synthetic drug types, synthetic cannabinoids and synthetic cathinones, and the hallucinogen Salvia divinorum. These substances comprise part of a rapidly evolving and controversial drug market that has challenged definitions of what is legal and illegal, has benefitted from open commercial sales without regulatory oversight, and is noteworthy for the pace at which new substances are introduced. This emerging trend in substance use presents significant and unique public health and criminal justice challenges. At this time, these substances are not detected in routine drug screens and substance-specific treatment for cases of use-related toxicity are not available. Clinicians are encouraged to learn characteristic signs associated with misuse of novel drugs to recognize cases in their practice, and are recommended to use a symptom-specific approach for treatment in each case.

Constructing an Urban Drug Ecology in 1970s Canada

In 1970, youthful researchers carried out participant-observer studies of the drug scene in Vancouver, Winnipeg, Toronto, Montreal, and Halifax. This ethnographic research, prepared for the federal Commission of Inquiry into the Non-Medical Use of Drugs (the LeDain Commission), was part of the commission’s extensive series of unpublished studies. The commission, which released an initial report in 1970, one on cannabis in 1972 and a final report in 1973, adopted a broad approach to the issue of drugs and society. This article examines the unpublished studies as examples of social science “intelligence gathering” on urban social problems. The reports discussed the local market in illegal drugs, its geographic patterns and organizational features, the demographic characteristics of drug sellers and consumers, the culture of the drug scene, and the attitudes of users. Unlike earlier sociological and anthropological studies that focused on prisoners and lower-class “junkies” or more recent studies that examine marginalized inner-city populations, the city studies reflected the era’s fixation on middle-class youth culture and the addiction-treatment sphere’s growing concern with amphetamine abuse.

Just How Cognitive Is “Cognitive Enhancement”? On the Significance of Emotions in University Students’ Experiences with Study Drugs

Numerous deliberations on the ethics of cognitive enhancement take as their primary case the nonmedical use of prescription stimulant drugs by university students seeking to improve their performance in relation to academic work. Almost without exception, such discussions suggest that these medications enable academic performance enhancement through effects on cognitive processes. This article reports findings from qualitative research with nonmedical users that indicate that stimulants’ effects on users’ emotions and feelings are an important contributor to users’ perceptions of improved academic performance. On the basis of these findings, the article suggests the conceptualization of nonmedical use of stimulants in terms of “cognitive enhancement” may fail to adequately capture the perspectives and experiences of individuals who use stimulant drugs as study aids.

The use of erection enhancing medication and party drugs among men living with HIV in Europe

Studies have shown more erectile dysfunction (ED) in men living with HIV (MLHIV), relative to age matched HIV-negative men. Erection enhancing medication (EEM) is more frequently used by HIV-positive men than in the general male population. Increased sexually transmitted infection has been described in HIV-positive men with ED using EEM. This study investigated the use of EEM and party drugs (methyleendioxymethamfetamine (XTC), gammahydroxybutyrate (GHB) “fluid XTC” and alkyl nitrites “poppers”) among MLHIV. Self-administered questionnaires were distributed consecutively to all patients attending 17 European HIV treatment centers. The sample included 1118 HIV-positive men, among whom 74.5% men having sex with men (MSM). The use of EEM was more frequent in MSM than in heterosexual men (odds ratio (OR) 3.33, p<0.001) and was associated with increased sexual risk behavior (OR 3.27, p<0.001). Nonmedically indicated use of EEM was linked to increased use of party drugs (OR 2.30, p=0.01). Physicians taking care of MLHIV need to be aware of the high prevalence of (nonmedical) use of EEM and party drugs. Medical provision of EEM should be combined with a discussion on safer sex behavior and the risk related to concomitant use of party drugs and illegal EEM.

Increasing use of nonmedical analgesics among younger cohorts in the United States: a birth cohort effect.

Nonmedical use of prescription pain drugs (hereafter "analgesics") has increased substantially in recent years. It is not known whether today's youth are disproportionately driving this increase or, instead, the trend is a general one that has affected cohorts of all ages similarly. To address this question we present the first age-period-cohort analysis of nonmedical use of analgesics. Data come from the National Survey on Drug Use and Health, a series of annual, nationally representative, cross-sectional surveys of the US civilian, noninstitutionalized population. The analysis focuses on the years 1985-2009 and uses the recently developed "intrinsic estimator" algorithm to disentangle age-period-cohort effects. Substantial increases in the prevalence of nonmedical analgesics use (NAU) have occurred across all cohorts and ages in recent years, but this increase is significantly amplified among today's adolescents. The odds of past-year NAU for today's youngest cohort (born 1980-1994) are higher than would be expected on the basis of their age and broad, historical period influences that have increased use across people of all ages and cohorts. The independent influence of cohort on past-year NAU is about 40% higher for today's youth cohort than any of the cohorts that came before them. This finding is present among men, women, non-Hispanic whites, non-Hispanic blacks, and Hispanics. Although nonmedical use of analgesics is evident among all ages, cohorts, and periods, today's younger cohorts warrant special attention for substance abuse policies and interventions targeted at reversing the increase in NAU.

Combined Motivational Interviewing and Cognitive-Behavioral Therapy with Older Adult Drug and Alcohol Abusers

More than 2.5 million older Americans struggle with alcohol abuse and its associated medical and social consequences. This number is expected to double to 5 million by 2020 (Gfoerer, Penne, Pemberton, & Folsom, 2003). Marijuana is the most commonly used illicit drug among older people followed by the nonmedical use of prescription drugs (Bartles, Blow, Brockmann, & Van Citters, 2005). The number of marijuana users age 50 and over is expected to grow from the current 719,000 to 3.3 million by 2020. It is estimated that one in four older adults use psychotropic drugs with abuse potential and that nonmedical use of such drugs will increase from the current 911,000 to 2.7 million by 2020 (Colliver, Compton, Gfroerer, & Condon, 2006; Simoni-Wastila & Yang, 2006). Comorbidity of drug and alcohol use is also a problem among older drug and alcohol users. Older people with alcohol disorders are at high risk for prescription drug abuse (Culberson & Ziska, 2008). Overall, physical and mental difficulties related to combined misuse of alcohol and medications affect up to 19 percent of the older population (Bartles et al., 2005; Cummings & Cooper, 2011). The combination of drugs, such as marijuana, with alcohol and prescription medications can lead to decreased cognition, impairment of memory and attention, and increased falls (Benshoff, Harrawood, & Koch, 2003). Comorbid psychiatric illness, including depression and anxiety, are also common among elderly drug and alcohol abusers. Additionally, older adults who use alcohol and marijuana have a higher risk of suicide (Rigler, 2000). Substance abuse and the related physical and mental comorbidities are expected to rise among the population of older adults in the coming decades. This increase in substance abuse among the older adult population coupled with the high comorbidity of substance misuse with mental and physical health disorders presents many challenges to the current treatment system. The Older Adult Healthy Living Program (HELP) was developed to address these challenges. This article describes both the barriers to older adult treatment effectiveness and the means by which HeLP overcomes these barriers. BARRIERS TO EFFECTIVE OLDER ADULT TREATMENT Older people see medical professionals frequently, which makes medical offices an efficacious place to screen for alcohol and drug use among this population. However, studies indicate that medical professionals overlook substance abuse and misuse among older people (O'Connell, Chin, Cunningham, & Lawlor, 2003), Additionally, medical professionals are often unaware of the special physiological vulnerabilities to substances that the elderly experience and of the altered substance use guidelines established for older adults (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2005; Simoni-Wastila & Yang, 2006), For these reasons, medical professionals underdiagnose older patients with alcohol and drug abuse disorders and rarely refer their older clients to substance abuse treatment (Weintraub et al., 2002). Poor communication among prescribing physicians (Benshoff et al., 2003), lack of physician inquiry concerning older patients' medication concerns (Alemagno, Niles, & Treiber, 2004), and medical professionals' failure to determine whether an older patient uses alcohol or other substances along with prescription medication (Simoni-Wastila & Yang, 2006) contribute to the lack of recognition of alcohol and drug abuse by older adults as well. Older people often do not recognize the signs of addiction and, therefore, do not present for treatment. They often perceive the negative effects of substance use as a natural consequence of aging (Benshoff et al., 2003). They sometimes engage in dangerous behavior such as borrowing medications from a friend, taking medications for other than approved purposes, and taking higher than prescribed doses, without realizing the potentially dangerous effects of such behaviors (Simoni-Wastila & Yang, 2006). …

Opioid Epidemic in the United States

Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain. Key words: Opioid abuse, opioid misuse, nonmedical use of psychotherapeutic drugs, nonmedical use of opioids, National Survey on Drug Use and Health, opioid guidelines.

Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States

Objectives: To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50–64 years of age with those 65+ years of age (N = 10,891). Methods: Data were from the 2008–2009 US National Surveys on Drug Use and Health. Results: Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50–64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8% vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past-year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group. Conclusions: Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.

Smart Drugs “As Common As Coffee”: Media Hype about Neuroenhancement

BackgroundThe use of prescription drugs to improve cognitive functioning in normal persons –“neuroenhancement” – has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement.AimsWe conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles.MethodsUsing the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned.Results87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users.ConclusionsNews media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.

Prescription drug misuse among university staff and students: A survey of motives, nature and extent

Aims: To determine the prevalence and nature of prescription drug misuse among university staff and students in the UK.Methods: In 2009, an online questionnaire regarding non-medical use of prescription drugs was completed by 1614 students and 489 staff registered at a large university in Wales. The sample data were weighted to match the population of students and staff and were analysed using SPSS.Findings: The lifetime prevalence of prescription drug misuse (using prescription drugs not prescribed to the person) was 33% among students and 24% among staff. The main medications misused were pain relievers, followed by sedatives and sleeping aids. The main motives for misusing prescription drugs were to gain therapeutic benefit and ‘to get high’.Conclusions: The study shows that a notable proportion of staff and students at the university used prescription drugs in a way that was not intended. The discussion draws attention to a debate about whether all forms of non-medical drug use should be regarded as misuse. The implications of non-medical use include health risks to the user as well as hidden social and economic costs. More research should be done to generate a more in-depth understanding of prescription drug misuse.

Trends over time in characteristics of pharmaceutical drug‐related ambulance attendances in Melbourne

There is growing concern regarding pharmaceutical drug-related harms. Evidence suggests increasing non-medical use of pharmaceutical drugs, along with associated morbidity and mortality. This paper explores trends of pharmaceutical-related ambulance attendances over the past decade in order to identify populations experiencing acute harm, and levels of harms in the community. A retrospective analysis of pharmaceutical drug-related ambulance attendances in metropolitan Melbourne, Australia, is presented, with rates of attendances over the period 2000 to 2009 and change over time examined. Characteristics of attendances are explored to understand the nature of presentation and demographic characteristics. Benzodiazepines represented the drug group with the highest rates of attendances over the 10 year period. Rates of attendances increased significantly for opioid analgesics, while significant decreases were noted for benzodiazepines, antidepressant and anticonvulsants. While women represented the majority of patients for each drug category presented over the period examined, there was an increase in the proportion of men attended in relation to opioid analgesics. Alcohol involvement in presentations has increased significantly for all drug groups. Increasing pharmaceutical-related ambulance attendances for opioid analgesics reflect increasing use, with the increase in other analgesic-related attendances also concerning. The overrepresentation of female patients reflects a population experiencing drug-related harm not reflected in illicit drug research. The rise of alcohol involvement represents heightened risk of adverse events including death, and suggests an area for public education to prevent alcohol and drug-related harms.

Opioids: Nonmedical Use and Abuse in Older Children

1. William A. Frese, MD* 2. Kimberly Eiden, APN† 1. *Assistant Professor, Department of Pediatrics, Medical College of Wisconsin and Children's Research Institute, Milwaukee, WI. Formerly Department of Pediatrics, Advocate Hope Children's Hospital, Oak Lawn, IL. 2. †Department of Pediatrics, Advocate Hope Children's Hospital, Oak Lawn, IL. After completing this article, readers should be able to: 1. Characterize the prevalence of overall pediatric opioid use, both medical and nonmedical. 2. Identify demographic and clinical characteristics associated with pediatric nonmedical opioid use. 3. Discuss abuse and dependence comorbidities associated with pediatric nonmedical use of opioids. 4. Describe the pediatrician's role in prevention and screening for pediatric nonmedical prescription opioid use. 5. Explain opioid overdose management. Alone or in combination with other pain management modalities, the use of opioids can be a mainstay of adequate analgesia. However, increased prescribing and availability of opioid medications correlate with overall medication abuse and misuse rates. Prescription drug nonmedical use is second only to marijuana as the most common form of newly initiated illicit drug use (Fig. 1). (1) Surveys among adolescent populations similarly support a high incidence of nonmedical opioid medication use. (1)(2) Nonmedical opioid use rates among 12- to 17-year-old children have stabilized (Fig. 2), (3) but the overall prevalence of such inappropriate use may prompt pediatricians to consider decreasing opioid prescribing and potentially undertreat pain in an attempt to reduce the abuse of these medications. Pediatricians must be knowledgeable about the prevalence of pediatric nonmedical opioid use, its pattern, and appropriate prevention strategies. This article reviews the nonmedical use of prescription opioids in the pediatric population. The characteristics of such usage are incorporated into prevention, screening, and management strategies. Figure 1. Specific drug employed when initiating illicit drug use among initiates of illicit drugs ages 12 years or older in the past year. Reproduced with permission from Results From the 2008 National Survey on Drug Use and Health: National Findings . (1) Figure 2. Nonmedical …

Alcohol, Tobacco, and Nonmedical Drug Use Disorders in U.S. Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions

To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older. The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample. The United States. Eight thousand two hundred five adults aged 65 years and older. Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders. Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder. More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Contrast of medical and nonmedical use of stimulant drugs, basis for the distinction, and risk of addiction: Comment on Smith and Farah (2011).

Smith and Farah (2011) presented a scholarly review of critical areas related to their intriguing title "Are Prescription Stimulants 'Smart Pills'?" We contend that they accomplished the main goal of the article, to get the facts straight about possible cognitive enhancement via the nonmedical use of stimulant drugs by individuals without a diagnosis of attention-deficit/hyperactivity disorder (ADHD). At the same time, they justified their main conclusions that (a) individuals are seeking and engaging in nonmedical use of stimulant drugs with the expectations of cognitive enhancement despite uncertainty whether such expectations are valid and (b) on some tasks, there are small average benefits of nonmedical use, but the overall pattern is not clear (e.g., small beneficial effects across most individuals or large beneficial effects only in a few individuals, both of which result in small average effects). We offer comments in 3 areas to amplify key topics mentioned but not emphasized by Smith and Farah: (a) characterization of the cognitive effects of medical use of stimulants to contrast with the cognitive effects of nonmedical use; (b) justification of medical use of stimulants by placement on a normally distributed dimension of behavior rather than categorical diagnosis of ADHD, which varies widely across countries; and (c) evaluation of the potential risks of nonmedical use to individuals and to society (e.g., the likelihood of addiction to stimulant drugs in a small minority of the population) rather than just the potential benefits of cognitive enhancement.

Illicit and Nonmedical Drug Use Among Older Adults: A Review

Substance abuse among older adults is a looming public health concern. The number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002-2006 to 5.7 million in 2020. The authors provide a review of epidemiological findings for this understudied area of research by focusing on illicit drug use disorders and nonmedical use of prescription drugs among adults aged 50+ years. MEDLINE and PsychInfo were searched using keywords drug use, drug abuse, drug misuse, substance use disorder, and prescription drug abuse. Using the related-articles link, additional articles were screened for inclusion. This review included articles published between 1990 and 2010. Rates of treatment admissions involving primary use of illicit and misuse of prescription drugs have increased, while rates involving primary use of alcohol only have decreased. Alcohol, opioids/heroin, and cocaine were more likely than other substances to be associated with treatment use. Limited research data suggested the effectiveness of treatments, especially for women. Furthermore, older adults appeared to be less likely than younger adults to perceive substance use as problematic or to use treatment services. There is robust evidence showing that an increased number of older adults will need substance abuse care in the coming decades. Increasing demands on the substance abuse treatment system will require expansion of treatment facilities and development of effective service programs to address emerging needs of the aging drug-using population.

Effects of Team Climate on Substance Use Behaviors, Perceptions, and Attitudes of Student-Athletes at a Large, Public University

College student-athletes comprise a special group on the college campus owing to their dual roles as students and athletes. Although many positives are associated with being a student-athlete (Nelson & Wechsler, 2001), researchers have found that this population is faced with unique academic, physical, and social stressors that put student-athletes at greater risk for substance use than their nonathlete peers (e.g., Baer, 2002; Hildebrand, Johnson, & Bogle, 2001; Huang, Jacobs, Derevensky, Gupta, & Paskus, 2007; Presley, Meilman, & Leichliter, 2002; Wilson, Pritchard, & Schaffer, 2004). These studies have indicated that college student-athletes binge drink at higher rates than nonathletes and that binge drinking tends to increase as participation in athletics increases. In addition, Leinfelt and Thompson (2004) found that student-athletes were three times more likely to be arrested for alcohol-related behaviors than nonathletes. However, studies comparing the non-medical drug use of student-athletes and their peers have been inconclusive, with Huang and coworkers (2007) and Wechsler, Davenport, Dowdell, and Grossman (1997) finding lower rates of drug use among college student-athletes compared with the findings of Nattiv and Puffer (1991) and Rockafellow and Saules (2006), which showed higher rates of drug use among the student-athlete population. The work of Rockafellow and Saules has suggested that extrinsic motivation within the athletic community may impact the higher rates of substance use among the student-athlete population.

Anxiolytic and hypnotic drug misuse in Thailand: Findings from a national household survey

The non-medical use of prescription drugs, such as anxiolytics and hypnotics, has become a growing public health problem in Thailand. The objective of this study was to examine the patterns of non-medical use of these drugs, using data from a nationally representative sample of Thais interviewed in 2007. A nationwide, multi-stage, household survey of 26 633 respondents aged 12-65 years living in 11 348 households throughout Thailand using a face-to-face structured interview questionnaire was carried out. In 2007, 1.58% (734 288) and 1.58% (733 318) of Thais indicated that they had misused anxiolytics or hypnotics, respectively, at some time during their lives. Less than 1% had misused these drugs during the 12 months preceding the interview (426 170 or 0.92% for anxiolytics, 372 920 or 0.80% for hypnotics), fewer during the preceding 30 days (234 871 or 0.50% for anxiolytics, 225 638 or 0.48% for hypnotics).The highest prevalence of past 30 day use was in Bangkok, the lowest in Southern Thailand. More women than men, older than younger respondents, and subjects who considered they were in poor physical health or had emotional problems than those who thought otherwise used the drugs during the 30 days before the interviews. The prevalence of anxiolytic/hypnotic misuse/abuse appears to be lower than that reported from more developed countries, but a small increase in problems resulting from the use of these substances has a disproportionately large effect on the overstretched resources of a developing country.