VISIT TREATMENT PROGRAM AND ANSWER QUESTIONS FROM THE WORD DOCUMENT. PLEASE FOLLOW ALL DIRECTIONS CLOSELY.
THIS ASSIGNMENT HAS A MININUM WORD REQUIREMENT
TREATMENT PROGRAM VISIT
Pretend Visit a treatment program of your choice that you have never visited before. Ask to attend a meeting or observe the program or service in action. The following are some suggestions but you can find others in your area. If circumstances prevent you from visiting in person, such as being on a ship or living abroad, then participate in a video or phone meeting.
12 step Groups
A Alcoholics Anonymous
https://www.aa.org/pages/en_US/find-local-aa
phone meetings
ACA Adult Children of Alcoholics
Al-Anon/Alateen, for friends and families ofalcoholics
CA Cocaine Anonymous
CMA Crystal Meth Anonymous
Co-Anon, for friends and family ofaddicts
HA Heroin Anonymous
MA Marijuana Anonymous
NA Narcotics Anonymous
N/A Neurotics Anonymous, for recovery frommental and emotional illness
Nar-Anon, for friends and family members ofaddicts
NicA Nicotine Anonymous
Note: 12 step programs are very welcoming and friendly to visitors and they will be very glad that you are visiting. You are allowed to attend any in-person, phone or video meetings that are designated as OPEN. They regularly have students and other visitors from time to time. You dont have to make an appointment or notify them in advance. If you go in person, try to arrive early so you can tell the meeting leader that you are a student and would like to observe. As a visitor, you dont speak during the meeting and remember to respect the anonymity of the participants.
Many students who attended a 12 step meeting had a very positive and valuable experience. If you have never been to one, this would be a great opportunity for you. Search online for meetings in your area of the 12 step group you choose to visit. Many of them meet multiple times each day so it should be easy to find a meeting that fits into your schedule.
Below are suggestions for other treatment programs you could visit but feel free to choose any treatment program you would like:
Substance Use Disorders Treatment Programs in San Diego County
https://www.sandiegocounty.gov/content/sdc/hhsa/programs/bhs/alcohol_drug_services/dmc_ods_consumer.html
Scroll to the bottom of the page.
Smoking Cessation programs in California
https://www.nobutts.org/county-listing
You will need to check the program to see if they will allow you to visit and if they will allow you to observe their work.
Then write about the visit without violating the anonymity of the participants. Do not use any quotations. Write everything in your own words.
a. NAME/DATE: Name of the program/organization and date of in-person visit or phone meeting if you cant attend in person
b. HOW THE PROGRAM OR SERVICE OPERATES: How does the program or service operate? Give as much detail as possible. Your answer should be at least 150 words
c. COMPONENTS: Does it use any of the components listed in the textbook on pages 323-325? Give as much detail as possible.
d. WHAT SURPRISED ME: What surprised you about the program or service?
e. WHAT I LEARNED: What did you learn from your experience of attending a meeting or visiting and/or observing the program or service? Give as much detail as possible. Your answer should be at least 150 words
Format: You do not need to cite anything or use APA format
Use the following headings:
A. Name/date
B. How the program or service operates Your answer should be at least 150 words
C. Components
D. What surprised me
E. What I learned Your answer should be at least 150 words
IMPORTANT: Do NOT submit your first draft. First, read what you wrote out loud. Check for:
Missing words or letters
Missing or misplaced periods, apostrophes, commas
Incomplete sentences
2 or more sentences strung together that should be made into separate sentences
Putting something in past tense that should be in present tense or vice versa
Plural words that should be singular or singular words that should be plural Boston Columbus Indianapolis New York San Francisco Upper Saddle River
Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montral Toronto
Delhi Mexico City So Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo
Charles F. levinthal
hofstra University
Eighth Edition
Drugs, Behavior,
and Modern
society
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Library of Congress Cataloging-in-Publication Data
Levinthal, Charles F.
Drugs, behavior, and modern society / Charles F. Levinthal, Hofstra University. Eighth
edition.
pages cm
Includes index.
ISBN-13: 978-0-205-95933-4
ISBN-10: 0-205-95933-4
1 . D r u g s . 2 . D r u g a b u s e . 3 . D r u g s P h y s i o l o g i c a l e f f e c t . 4 . P s y c h o t r o p i c
drugs. 5. Psychopharmacology. I. Title.
HV5801.L49 2014
362.29dc23
2013013402
10 9 8 7 6 5 4 3 2 1
ISBN-10: 0-205-95933-4
ISBN-13: 978-0-205-95933-4
For my grandsons
aaron Matthew levinthal
and
Michael samuel levinthal
This page intentionally left blank
Brief Contents v
BriEf ContEnts
Part onE drugs in society/drugs in our Lives 1
Chapter 1 Drugs and Behavior today 1
Chapter 2 Drug-taking Behavior: personal and social issues 28
Chapter 3 how Drugs Work in the Body and on the Mind 60
Part two Legally restricted drugs in our society 89
Chapter 4 the Major stimulants: Cocaine and amphetamines 89
Chapter 5 Opioids: Opium, heroin, and Opioid pain Medications 118
Chapter 6 lsD and Other hallucinogens 143
Chapter 7 Marijuana 167
Part thrEE Legal drugs in our society 191
Chapter 8 alcohol: social Beverage/social Drug 191
Chapter 9 Chronic alcohol abuse and alcoholism 220
Chapter 10 nicotine and tobacco Use 248
Chapter 11 Caffeine 275
Part four Enhancers and depressants 293
Chapter 12 performance-enhancing Drugs and Drug testing in sports 293
Chapter 13 Depressants and inhalants 315
Part fivE Medicinal drugs 339
Chapter 14 prescription Drugs, Over-the-Counter Drugs, and Dietary
supplements 339
Chapter 15 Drugs for treating schizophrenia and Mood Disorders 362
Part six Prevention and treatment 379
Chapter 16 substance-abuse prevention 379
Chapter 17 substance-abuse treatment: strategies for Change 407
This page intentionally left blank
Contents vii
ContEnts
preface xix
Part onE drugs in society/
drugs in our Lives 1
Chapter 1
Drugs and Behavior today 1
By the Numbers . . . 2
Social Messages About Drug Use 3
Two Ways of Looking at Drugs and Behavior 4
A Matter of Definition: What Is a Drug? 5
h E a L t h L i n E : Defining Drugs: Olive Oil,
Curry Powder, and a Little Grapefruit? 6
Instrumental Drug Use/Recreational Drug Use 6
Drug Misuse or Drug Abuse? 7
d r u g s . . . i n f o C u s : Drug Abuse and the
College Student: An Assessment Tool 8
Drugs in Early Times 9
Drugs in the Nineteenth Century 10
Drugs and Behavior in the Twentieth Century 11
Drugs and Behavior from 1945 to 1960 12
Drugs and Behavior after 1960 12
Q u i C k C o n C E P t C h E C k 1 . 1 :
Understanding the History of Drugs and
Behavior 13
Present-Day Attitudes toward Drugs 14
Patterns of Drug Use in the United States 14
Illicit Drug Use among High School Seniors 15
Illicit Drug Use among Eighth Graders and Tenth
Graders 16
Illicit Drug Use among College Students 16
Alcohol Use among High School and College Students 16
Tobacco Use among High School and College Students 17
Drug Use and Drug Perceptions 17
Illicit Drug Use among Adults Aged Twenty-Six and
Older 18
Making the Decision to Use Drugs 19
Q u i C k C o n C E P t C h E C k 1 . 2 :
Understanding Present-Day Drug Use in the United
States 19
Specific Risk Factors 19
Specific Protective Factors 21
Present-day Concerns 21
Club Drugs 21
Nonmedical Use of Prescription Pain Relievers 21
d r u g s . . . i n f o C u s : Facts about
Club Drugs 22
Nonmedical Use of Prescription Stimulant Medications 23
Nonmedical Use of Over-the-Counter Cough-and-Cold
Medications 23
Why Drugs? 23
P o r t r a i t : From Oxy to Heroin
The Life and Death of Erik 24
Summary 24 / Key Terms 25 / Endnotes 26
Chapter 2
Drug-taking Behavior: personal
and social issues 28
By the Numbers . . . 29
Drug Toxicity 30
d r u g s . . . i n f o C u s : Acute Toxicity in
the News: Drug-Related Deaths 32
Q u i C k C o n C E P t C h E C k 2 . 1 :
Understanding Dose-Response Curves 33
The DAWN Reports 33
Emergencies Related to Illicit Drugs 34
Drug-Related Deaths 34
Judging Drug Toxicity from Drug-Related Deaths 35
Demographics and Trends 35
From Acute Toxicity to Chronic Toxicity 36
Behavioral Tolerance and Drug Overdose 37
Q u i C k C o n C E P t C h E C k 2 . 2 :
Understanding Behavioral Tolerance through
Conditioning 38
Physical and Psychological Dependence 39
Physical Dependence 39
Psychological Dependence 39
Diagnosing Drug-Related Problems: The Health
Professionals Perspective 41
viii Contents
Special Circumstances in Drug Abuse 43
Drug Abuse in Pregnancy 43
Drug Abuse and HIV Infection 43
h E a L t h L i n E : Effects of Psychoactive Drugs
on Pregnant Women and Newborns 44
Drugs, Violence, and Crime 45
Pharmacological Violence 45
Economically Compulsive Violence 46
Systemic Violence 47
Governmental Policy, Regulation, and Laws 48
Efforts to Regulate Drugs, 19001970 48
Rethinking the Approach toward Drug Regulation,
1970Present 49
Drug Law Enforcement and Global Politics 50
P o r t r a i t : Pablo EscobarFormerly Known
as the Colombian King of Cocaine 51
h E a L t h L i n E : Harm Reduction as a National
Drug-Abuse Policy 53
Summary 54 / Key Terms 55 / Endnotes 55
P o i n t / C o u n t E r P o i n t i : Should We
Legalize Drugs in General? 58
Chapter 3
how Drugs Work in the Body
and on the Mind 60
By the Numbers . . . 61
How Drugs Enter the Body 61
Oral Administration 61
Injection 62
Inhalation 63
Absorption through the Skin or Membranes 63
How Drugs Exit the Body 64
d r u g s . . . i n f o C u s : Ways to Take
Drugs: Routes of Administration 65
Factors Determining the Behavioral Impact of Drugs 66
Timing 66
Drug Interactions 67
Cross-Tolerance and Cross-Dependence 67
Q u i C k C o n C E P t C h E C k 3 . 1 :
Understanding Drug Interactions 67
h E a L t h a L E r t : Adverse Effects of Drug
Drug and FoodDrug Combinations 68
Individual Differences 69
Introducing the Nervous System 69
The Peripheral Nervous System 70
Sympathetic and Parasympathetic Responses 70
The Central Nervous System 71
Understanding the Brain 72
The Hindbrain 73
The Midbrain 73
The Forebrain 73
Q u i C k C o n C E P t C h E C k 3 . 2 :
Understanding Drugs and Brain Functioning 74
Understanding the Neurochemistry of Psychoactive
Drugs 74
Introducing Neurons 74
Neuronal Communication 75
Drug Influences on Neuronal Communication 76
The Major Neurotransmitters in Brief:
The Big Seven 76
Physiological Aspects of Drug-Taking Behavior 78
The BloodBrain Barrier 78
d r u g s . . . i n f o C u s : Endorphins,
Endocannabinoids, and the Runners High 79
Biochemical Processes Underlying Drug Tolerance 80
Q u i C k C o n C E P t C h E C k 3 . 3 :
Understanding Cross-Tolerance and
Cross-Dependence 80
Physiological Factors in Psychological Dependence 81
h E a L t h L i n E : Drug Craving and the Insula
of the Brain 82
Psychological Factors in Drug-Taking Behavior 82
Expectation Effects 83
P o r t r a i t : Nora D. VolkowA Scientist-
General in the War on Drugs 84
Drug Research Procedures 85
Summary 85 / Key Terms 86 / Endnotes 86
Part two Legally restricted
drugs in our society 89
Chapter 4
the Major stimulants: Cocaine
and amphetamines 89
By the Numbers . . . 90
The History of Cocaine 90
Cocaine in Nineteenth-Century Life 91
Contents ix
h E a L t h a L E r t : Cocaine after Alcohol:
The Risk of Cocaethylene Toxicity 91
Freud and Cocaine 92
d r u g s . . . i n f o C u s : What Happened
to the Coca in Coca-Cola? 93
Q u i C k C o n C E P t C h E C k 4 . 1 :
Understanding the History of Cocaine 94
Acute Effects of Cocaine 94
Chronic Effects of Cocaine 95
h E a L t h a L E r t : The Physical Signs
of Possible Cocaine Abuse 95
Medical Uses of Cocaine 96
How Cocaine Works in the Brain 96
Present-Day Cocaine Abuse 96
From Coca to Cocaine 97
From Cocaine to Crack 97
d r u g s . . . i n f o C u s : Crack Babies
Revisited: What Are the Effects? 99
Patterns of Cocaine Abuse 100
Treatment Programs for Cocaine Abuse 100
d r u g s . . . i n f o C u s : Paco: A Cheap
Form of Cocaine Floods Argentine Slums
and Beyond 100
P o r t r a i t : Robert Downey Jr. and
OthersCleaning Up after Cocaine 101
Amphetamines 103
The Different Forms of Amphetamines 103
The History of Amphetamines 104
How Amphetamines Work in the Brain 104
Acute Effects of Amphetamines 104
Chronic Effects of Amphetamines 105
Methamphetamine Abuse 105
Present-Day Patterns of Methamphetamine Abuse 105
d r u g s . . . i n f o C u s : Methamphetamine
and the Heartland of America 107
Methamphetamine-Abuse Treatment 107
Q u i C k C o n C E P t C h E C k 4 . 2 :
Understanding Patterns of Cocaine and
Methamphetamine Abuse 108
Medical Uses for Amphetamines and Similar
Stimulant Drugs 108
h E a L t h L i n E : Bath Salts as a New Form
of Stimulant Abuse 109
Stimulant Medications for ADHD 109
Other Medical Applications 110
Stimulant Medication and Cognitive
Enhancement 111
Summary 111 / Key Terms 112 / Endnotes 112
P o i n t / C o u n t E r P o i n t i i : Should
Cognitive Performance-Enhancing Drugs Be
Used by Healthy People? 116
Chapter 5
Opioids: Opium, heroin, and Opioid
pain Medications 118
By the Numbers . . . 119
Opium in History 119
The Opium War 121
Opium in Britain and the United States 122
Morphine and the Advent of Heroin 123
Opioids in American Society 124
Opioid Use and Heroin Abuse after 1914 124
Heroin Abuse in the 1960s and 1970s 125
Heroin and Other Opioids since the 1980s 126
Q u i C k C o n C E P t C h E C k 5 . 1 :
Understanding the History of Opium and
Opioids 127
Effects on the Mind and the Body 127
How Opioids Work in the Brain 128
Patterns of Heroin Abuse 129
Tolerance and Withdrawal Symptoms 130
The Lethality of Heroin Abuse 130
Q u i C k C o n C E P t C h E C k 5 . 2 :
Understanding the Effects of Administering
and Withdrawing Heroin 131
Heroin Abuse and Society 132
Treatment for Heroin Abuse 132
Heroin Detoxification 132
Methadone Maintenance 133
Alternative Maintenance Programs 134
Behavioral and Social-Community
Programs 134
Medical Uses of Opioid Drugs 134
h E a L t h a L E r t : Sustained-Release
Buprenorphine: A New Era in Heroin-Abuse
Treatment 135
Beneficial Effects 135
Prescription Pain Medication Misuse and Abuse 137
OxyContin Abuse 137
Responses to OxyContin Abuse 137
x Contents
P o r t r a i t : David LafferPharmacy Robber
and Killer of Four 138
Abuse of Other Opioids Pain Medications 138
Prevalence of Nonmedical Use of Opioid Pain
Medications 138
Summary 139 / Key Terms 140 / Endnotes 140
Chapter 6
lsD and Other hallucinogens 143
By the Numbers . . . 144
A Matter of Definition 144
Classifying Hallucinogens 145
Lysergic Acid Diethylamide (LSD) 146
d r u g s . . . i n f o C u s : Strange Days
in Salem: Witchcraft or Hallucinogens? 147
The Beginning of the Psychedelic Era 147
P o r t r a i t : Timothy LearyNutty Professor
or Psychedelic Visionary? 149
Acute Effects of LSD 149
Effects of LSD on the Brain 150
Patterns of LSD Use 151
Facts and Fiction about LSD 151
Will LSD Produce Substance Dependence? 151
Will LSD Produce a Panic Attack or Psychotic
Behavior? 151
Will LSD Increase Your Creativity? 152
Will LSD Damage Your Chromosomes? 152
h E a L t h a L E r t : Emergency Guidelines
for a Bad Trip on LSD 152
Will LSD Have Residual (Flashback) Effects? 153
Will LSD Increase Criminal or Violent Behavior? 153
Psilocybin and Other Hallucinogens Related to
Serotonin 154
Lysergic Acid Amide (LAA) 154
h E a L t h L i n E : Bufotenine and the Bufo
Toad 155
Dimethyltryptamine (DMT) 155
Harmine 156
Hallucinogens Related to Norepinephrine 156
Mescaline 156
DOM 156
d r u g s . . . i n f o C u s : Present-Day
Peyotism and the Native American Church 157
MDMA (Ecstasy) 157
h E a L t h a L E r t : MDMA Toxicity: The
Other Side of Ecstasy 158
Hallucinogens Related to Acetylcholine 159
Amanita muscaria 159
The Hexing Drugs and Witchcraft 159
Miscellaneous Hallucinogens 160
Phencyclidine (PCP) 161
Acute Effects of PCP 161
Q u i C k C o n C E P t C h E C k 6 . 1 :
Understanding the Diversity of
Hallucinogens 161
Patterns of PCP Abuse 162
Ketamine 162
Q u i C k C o n C E P t C h E C k 6 . 2 :
Understanding PCP 163
Salvia divinorum 163
Summary 163 / Key Terms 165 / Endnotes 165
Chapter 7
Marijuana 167
By the Numbers . . . 168
A Matter of Terminology 168
The History of Marijuana and Hashish 170
Hashish in the Nineteenth Century 170
Marijuana and Hashish in the Twentieth Century 170
The Anti-Marijuana Crusade 171
Challenging Old Ideas about Marijuana 172
Acute Effects of Marijuana 172
Acute Physiological Effects 173
Acute Psychological and Behavioral Effects 173
Q u i C k C o n C E P t C h E C k 7 . 1 :
Understanding the Effects of Marijuana 174
d r u g s . . . i n f o C u s : The Neurochemical
Yin and Yang of Cannabis 175
Effects of Marijuana on the Brain 175
Chronic Effects of Marijuana 176
Tolerance 176
Withdrawal and Dependence 176
Cardiovascular Effects 177
Respiratory Effects and the Risk of Cancer 177
Effects on the Immune System 178
Effects on Sexual Functioning and Reproduction 178
Long-Term Cognitive Effects and the Amotivational
Syndrome 178
Contents xi
The Gateway Hypothesis 179
The Sequencing Question 179
The Association Question 180
The Causation Question 180
Q u i C k C o n C E P t C h E C k 7 . 2 :
Understanding the Adverse Effects of Chronic
Marijuana Abuse 181
Patterns of Marijuana Smoking 181
Causes for Concern 182
h E a L t h a L E r t : A Synthetic Marijuana
called Spice 182
Medical Marijuana 183
Muscle Spasticity and Chronic Pain 183
P o r t r a i t : Marcy DolinMarijuana
Self-Medicator 183
Nausea and Weight Loss 184
The Medical Marijuana Controversy 184
The Issues of Decriminalization and Legalization 185
Summary 186 / Key Terms 187 / Endnotes 187
Part thrEE Legal drugs
in our society 191
Chapter 8
alcohol: social Beverage/social
Drug 191
By the Numbers . . . 192
What Makes an Alcoholic Beverage? 192
Alcohol Use through History 194
Alcohol in Nineteenth-Century America 194
The Rise of the Temperance Movement 195
The Road to National Prohibition 196
The Beginning and Ending of a Noble
Experiment 196
Present-Day Alcohol Regulation by Taxation 196
Patterns of Alcohol Consumption Today 197
Overall Patterns of Alcohol Consumption 197
h E a L t h L i n E : Multiple Ways of Getting
a Standard Drink 198
d r u g s . . . i n f o C u s : Visualizing the
Pattern of Alcohol Consumption in the United
States 199
Problematic Alcohol Consumption among College
Students 200
Alcohol Consumption among Adolescents 200
Q u i C k C o n C E P t C h E C k 8 . 1 :
Understanding Alcoholic Beverages 201
The Pharmacology of Alcohol 201
The Breakdown and Elimination of Alcohol 201
Measuring Alcohol in the Blood 202
h E a L t h L i n E : Gender, Race, and
Medication: Factors in Alcohol Metabolism 203
Effects of Alcohol on the Brain 204
Acute Physiological Effects 204
Toxic Reactions 205
Heat Loss and the Saint Bernard Myth 205
h E a L t h a L E r t : Emergency Signs and
Procedures in Acute Alcohol Intoxication 205
Diuretic Effects 206
Effects on Sleep 206
Effects on Pregnancy 206
Interactions with Other Drugs 206
Hangovers 206
Acute Behavioral Effects 207
Blackouts 208
Driving Skills 208
Preventing Alcohol-Related Traffic Fatalities among
Young People 209
P o r t r a i t : Candace LightnerFounder
of MADD 209
Alcohol, Violence, and Aggression 210
d r u g s . . . i n f o C u s : Alcohol, Security,
and Spectator Sports 211
d r u g s . . . i n f o C u s : Caffeine, Alcohol,
and the Dangers of Caffeinated Alcoholic Drinks 212
Sex and Sexual Desire 212
Alcohol and Health Benefits 212
Q u i C k C o n C E P t C h E C k 8 . 2 :
Understanding the Data from Balanced Placebo
Designs 213
h E a L t h a L E r t : Guidelines for Responsible
Drinking 214
Strategies for Responsible Drinking 215
Summary 215 / Key Terms 216 / Endnotes 216
Chapter 9
Chronic alcohol abuse
and alcoholism 220
Alcoholism: Stereotypes, Definitions,
and Life Problems 221
xii Contents
By the Numbers . . . 221
Problems Associated with a Preoccupation with
Drinking 221
Emotional Problems 223
Vocational, Social, and Family Problems 223
Physical Problems 223
h E a L t h L i n E : A Self-Administered
Short Michigan Alcoholism Screening Test
(SMAST) 224
Hiding the Problems: Denial and Enabling 224
Q u i C k C o n C E P t C h E C k 9 . 1 :
Understanding the Psychology of
Alcoholism 225
Alcohol Abuse and Alcohol Dependence: The Health
Professionals Perspective 225
Physiological Effects of Chronic Alcohol Use 226
Tolerance and Withdrawal 226
Liver Disease 226
Cardiovascular Problems 227
Cancer 227
Dementia and Wernicke-Korsakoff
Syndrome 228
Fetal Alcohol Syndrome (FAS) 228
h E a L t h L i n E : Alcoholism Screening
Instruments in Professional Use 230
Patterns of Chronic Alcohol Abuse 230
Gender Differences in Chronic Alcohol Use 231
Alcohol Abuse among the Elderly 231
The Family Dynamics of Alcoholism: A Systems
Approach 232
Children of an Alcoholic Parent or Parents 232
The Genetics of Alcoholism 233
The Concept of Alcoholism as a Disease 234
Approaches to Treatment for Alcoholism 235
Biologically Based Treatments 235
P o r t r a i t : Bill W. and Dr. BobFounders
of Alcoholics Anonymous 237
Alcoholics Anonymous 237
h E a L t h L i n E : Is Controlled Drinking
Possible for Alcoholics? 238
d r u g s . . . i n f o C u s : The Non-Disease
Model of Alcoholism and Other Patterns of
Substance Abuse 239
Q u i C k C o n C E P t C h E C k 9 . 2 :
Understanding Alcoholics Anonymous 240
SMART Recovery 240
Chronic Alcohol Abuse and Alcoholism in the
Workplace 240
Summary 241 / Key Terms 242 / Endnotes 242
P o i n t / C o u n t E r P o i n t i i i : Should
Alcoholism Be Viewed as a Disease? 246
Chapter 10
nicotine and tobacco Use 248
By the Numbers . . . 249
Tobacco Use through History 249
Politics, Economics, and Tobacco 250
Snuffing and Chewing 250
Cigars and Cigarettes 250
Tobacco in the Twentieth Century 251
Health Concerns and Smoking Behavior 252
h E a L t h L i n E : African Americans, Smoking,
and Mentholated Cigarettes 252
The Tobacco Industry Today 253
The Tobacco Settlement of 1998 254
The Tobacco Control Act of 2009 254
Tobacco Regulation and Global Economics 254
Whats in Tobacco? 254
Carbon Monoxide 255
Tar 255
Nicotine 256
The Dependence Potential of Nicotine 256
The Titration Hypothesis of Nicotine
Dependence 256
Tolerance and Withdrawal 257
Health Consequences of Tobacco Use 257
h E a L t h L i n E : Visualizing 400,000
to 440,000 Annual Tobacco-Related Deaths 257
Cardiovascular Disease 257
Respiratory Diseases 258
Lung Cancer 259
Other Cancers 259
Special Health Concerns for Women 260
The Hazards of Environmental Smoke 260
h E a L t h a L E r t : Signs of Trouble from
Smokeless Tobacco 261
Patterns of Smoking Behavior and Use of Smokeless
Tobacco 261
Q u i C k C o n C E P t C h E C k 1 0 . 1 :
Understanding the Effects of Tobacco Smoking 262
The Youngest Smokers 262
Contents xiii
Attitudes toward Smoking among Young People 262
Smokeless Tobacco 263
Cigars 264
Tobacco Use around the World 264
P o r t r a i t : Sigmund FreudNicotine
Dependence, Cigars, and Cancer 265
Quitting Smoking: The Good News and the Bad 265
The Good News: Undoing the Damage 266
The Bad News: How Hard It Is to Quit 266
h E a L t h L i n E : How to Succeed in Quitting
SmokingBy Really Trying 268
Nicotine Gums, Patches, Sprays, and Inhalers 268
The Role of Physicians in Smoking Cessation 268
A Final Word 269
Summary 270 / Key Terms 271 / Endnotes 271
Chapter 11
Caffeine 275
Coffee 276
By the Numbers . . . 276
Coffee in Britain and North America 276
Major Sources of Coffee 277
The Caffeine Content in Coffee 277
d r u g s . . . i n f o C u s : Why There Are No
(Live) Flies in Your Coffee 278
Tea 278
Tea in Britain and North America 278
The Chemical Content in Tea 279
Chocolate 279
How Chocolate Is Made 280
The Chocolate Industry Today 280
The Xanthine Content in Chocolate 280
h E a L t h L i n E : Chocolate, Flavanols, and
Cardiovascular Health 281
Soft Drinks 281
Caffeine from OTC Drugs and Other Products 281
P o r t r a i t : Milton S. Hershey and the Town
Built on Chocolate 282
Caffeine as a Drug 282
Q u i C k C o n C E P t C h E C k 1 1 . 1 :
Understanding Caffeine Levels in Foods and
Beverages 283
Effects of Caffeine on the Body 283
Effects of Caffeine on Behavior 283
Potential Health Benefits 284
Potential Health Risks 285
Cardiovascular Effects 285
Osteoporosis and Bone Fractures 285
h E a L t h L i n E : Coffee, Genes, and Heart
Attacks 286
Breast Disease 286
Effects during Pregnancy and Breastfeeding 286
Panic Attacks 286
Dependence, Acute Toxicity, and Medical
Applications 287
Tolerance 287
Withdrawal 287
Craving 287
Acute Toxicity of Caffeine 287
Prescription Drugs Based on Xanthines 288
Caffeine and Young People: A Special Concern 288
d r u g s . . . i n f o C u s : Energy Shots 289
Summary 289 / Key Terms 290 / Endnotes 290
Part four Enhancers and
depressants 293
Chapter 12
performance-enhancing Drugs
and Drug testing in sports 293
Drug-Taking Behavior in Sports 294
By the Numbers . . . 294
What Are Anabolic Steroids? 294
Anabolic Steroids at the Modern Olympic Games 295
P o r t r a i t : Lance Armstrong: From Honor
to Dishonor 297
Anabolic Steroids in Professional and Collegiate Sports 297
Performance-Enhancing Drug Abuse and Baseball 297
d r u g s . . . i n f o C u s : Suspension
Penalties for Performance-Enhancing Drug Use
in Sports 298
The Hazards of Anabolic Steroids 299
Effects on Hormonal Systems 299
Effects on Other Systems of the Body 300
Psychological Problems 300
Special Problems for Adolescents 301
Q u i C k C o n C E P t C h E C k 1 2 . 1 :
Understanding the Effects of Anabolic
Steroids 301
xiv Contents
Patterns of Anabolic Steroid Abuse 301
The Potential for Steroid Dependence 302
Counterfeit Steroids and the Placebo Effect 303
h E a L t h a L E r t : The Symptoms of Steroid
Abuse 304
Nonsteroid Hormones and Performance-Enhancing
Supplements 304
Human Growth Hormone 304
Dietary Supplements as Performance-Enhancing
Aids 305
Nonmedical Use of Stimulant Medication in
Baseball 306
Current Drug-Testing Procedures and Policies 306
The Forensics of Drug Testing 306
d r u g s . . . i n f o C u s : Pharmaceutical
Companies and Anti-Doping Authorities: A New
Alliance 307
Sensitivity and Specificity 308
Masking Drugs and Chemical Manipulations 308
Pinpointing the Time of Drug Use 309
Q u i C k C o n C E P t C h E C k 1 2 . 2 :
Understanding Drug Testing 310
The Social Context of Performance-Enhancing
Drugs 310
Summary 311 / Key Terms 312 / Endnotes 312
Chapter 13
Depressants and inhalants 315
By the Numbers . . . 316
Barbiturates 316
Categories of Barbiturates 317
Acute Effects of Barbiturates 317
d r u g s . . . i n f o C u s : Is There Any Truth
in Truth Serum? 318
Chronic Effects of Barbiturates 319
Current Medical Uses of Barbiturates 319
Patterns of Barbiturate Abuse 319
Nonbarbiturate Sedative-Hypnotics 320
The Development of Antianxiety Drugs 320
Benzodiazepines 321
Medical Uses of Benzodiazepines 321
Acute Effects of Benzodiazepines 322
Chronic Effects of Benzodiazepines 322
How Benzodiazepines Work in the Brain 323
Patterns of Benzodiazepine Misuse and Abuse 323
Nonbenzodiazepine Depressants 324
h E a L t h a L E r t : The Dangers of Rohypnol
as a Date-Rape Drug 324
Zolpidem and Eszopiclone 325
Buspirone 325
Beta Blockers 325
Antidepressants 325
Q u i C k C o n C E P t C h E C k 1 3 . 1 :
Understanding the Abuse Potential in Drugs 326
A Special Alert: The Risks of GHB 326
Acute Effects 326
Protective Strategies for Women 326
P o r t r a i t : Patricia White, GHB, and the
Perfect Crime 326
Inhalants through History 327
Nitrous Oxide 328
Ether 329
Glue, Solvent, and Aerosol Inhalation 329
The Abuse Potential of Inhalants 329
Acute Effects of Glues, Solvents, and Aerosols 330
The Dangers of Inhalant Abuse 330
h E a L t h a L E r t : The Signs of Possible
Inhalant Abuse 330
Patterns of Inhalant Abuse 331
d r u g s . . . i n f o C u s : Resistol and
Resistoleros in Latin America 332
The Dependence Potential of Chronic Inhalant
Abuse 333
Responses of Society to Inhalant Abuse 333
Q u i C k C o n C E P t C h E C k 1 3 . 2 :
Understanding the History of Inhalants 334
Summary 334 / Key Terms 335 / Endnotes 336
Part five Medicinal drugs 339
Chapter 14
prescription Drugs, Over-the-
Counter Drugs, and Dietary
supplements 339
By the Numbers . . . 340
The History of Prescription Drug Regulations 341
Procedures for Approving Prescription Drugs 342
Phases of Clinical Testing for Prescription Drugs 342
Patents and Generic Forms of Prescription Drugs 344
Contents xv
Speeding Up the FDA Approval Process 344
Procedures for Approving OTC Drugs 345
Are FDA-Approved Drugs Safe? 346
Q u i C k C o n C E P t C h E C k 1 4 . 1 :
Understanding the FDA Approval Process 346
The Issue of Speed versus Caution 346
Patterns of Prescription Drug Misuse 347
Unintentional Drug Misuse through Prescription
Errors 347
h E a L t h L i n E : The Potential for Death by
Prescription Error 348
h E a L t h L i n E : Doctor Shopping for
Prescription Drugs 349
Patterns of Prescription Drug Abuse 349
Major OTC Analgesic Drugs 349
Aspirin 350
Acetaminophen 351
Ibuprofen 351
Naproxen 352
OTC Analgesic Drugs and Attempted Suicide 352
Q u i C k C o n C E P t C h E C k 1 4 . 2 :
Understanding OTC Analgesic Drugs 352
Other Major Classes of OTC Drugs 352
Sleep Aids 352
Cough-and-Cold Remedies 353
The Pharmaceutical Industry Today 353
P o r t r a i t : Ryan Haight and the Ryan Haight
Act of 2008 354
Dietary Supplements 355
d r u g s . . . i n f o C u s : What W
