The Pharmacology of Alcohol and Drugs of Abuse and Addiction

358 Pages·1991·6.94 MB·English

by  Norman S. Miller M.D. (auth.)

The Pharmacology of Alcohol
and Drugs of Abuse and Addiction
Norman S. Miller
The Pharmacology of Alcohol
and Drugs of Abuse and Addiction
Springer-Verlag
New York Berlin Heidelberg London
Paris Tokyo Hong Kong Barcelona
Norman S. Miller, M.D.
Cornell University Medical College
New York Hospital-Cornell Medical Center
21 Bloomingdale Road
White Plains, New York 10605
USA
With 3 illustrations.
Library of Congress Cataloging-in-Publication Data
Miller, Norman S.
The pharmacology of alcohol and drugs of abuse and addiction /
Norman S. Miller.
p. cm.
Includes bibliographical references.
Includes index.
ISBN-13: 978-1-4612-7774-3 e-ISBN-13: 978-1-4612-3044-1
DOl: 10.1007/978-1-4612-3044-1
1. Alcoholism-Physiological aspects. 2. Substance abuse
Physiological aspects. 3. Alcohol-Physiological effect.
4. Psychotropic drugs - Physiological effect.
5. Neuropsychopharmacology. I. Title.
[DNLM: 1. Alcohol, Ethyl-pharmacology. 2. Narcotics
pharmacology. 3. Street Drugs-pharmacology. 4. Substance Abuse.
5. Substance Dependence. QV 84 M649pj
RC565.M444 1990
615'.78-dc20
DNLMIDLC
for Library of Congress 90-10046
Printed on acid-free paper.
© 1991 Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1s t edition 1991
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1}rpeset by Bytheway 'JYpesetting Services, Norwich, NY.
9 8 765 432 1
To my wife Nicole, and my daughters Mia and Natasha.
Persistent partisans who generously devoted their time
for this book.
Preface
This volume is intended for clinicians, researchers, residents, and students.
The range is wide and the depth considerable for all the topics covered in the
treatment of this timely and relevant subject. This book may serve equally
well as a general introduction and a scholarly reference. Ultimately, it is
designed to serve those patients suffering from abuse of and addiction to
drugs and alcohol.
The content and organization of the book flow from general concepts of
abuse and addiction to specific details of the pharmacology of alcohol and
drugs. Special chapters on topics not found in most other books, such as
pharmacology of drug-drug interactions, abstinence, and prevention, are
included.
This book is written especially for the clinician interested in the pharma
cology of alcohol and drugs of abuse and addiction. The pharmacology is
integrated into a conceptual approach to diagnosis and treatment of alcohol
and drug abuse and addiction.
The form and style are didactic, critical as well as straightforward in
presentation. Literature references from recent clinical research and basic
research provide the foundation for the chapters throughout the book. Be
cause the book is written by a clinician-researcher, the information is readily
adaptable to clinical problems and research ideas.
I would like to express my deep appreciation to Susan Newsom and
Darlene Tucci for their invaluable technical assistance.
Norman S. Miller
vii
Contents
Preface ....................................................... vii
CHAPTER 1
Introduction to the Pharmacological Effects of Alcohol and Drugs and
Addiction on the Brain and Behavior .... . . . . . . . . . . . . . . . . . . . . . . . . . .. 1
CHAPTER 2
The Behavioral Concepts of Abuse and Addiction in Diagnosis ........ 9
CHAPTER 3
The Neurochemistry of Tolerance, Dependence, and Addiction ........ 25
CHAPTER 4
Suicide in Alcoholism and Drug Addiction ......................... 45
CHAPTER 5
The Genetics of Alcoholism ..................................... 55
CHAPTER 6
The Medical Consequences of Alcohol and Drugs of Abuse
and Addiction ................................................. 63
CHAPTER 7
The Psychiatric Consequences of Alcohol and Drugs of Abuse
and Addiction ................................................. 77
CHAPTER 8
The Pharmacology of Alcohol and Drugs and Sexual Responsivity .... 89
CHAPTER 9
The Pharmacology of Alcohol .................................. 101
CHAPTER 10
The Pharmacology of Amphetamines ............................ 113
ix
x Contents
CHAPTER 11
The Pharmacology of Anabolic-Androgen Steroids ................ 125
CHAPTER 12
The Pharmacology of Benzodiazepines ........................... 133
CHAPTER 13
The Pharmacology of Cocaine .................................. 153
CHAPTER 14
The Pharmacology of Hallucinogens and Designer Drugs ........... 173
CHAPTER 15
The Pharmacology of Inhalants and Volatile Solvents .............. 185
CHAPTER 16
The Pharmacology of Marijuana (Cannabis) ...................... 199
CHAPTER 17
The Pharmacology of Multiple Drug and Alcohol Addiction ........ 215
CHAPTER 18
The Pharmacology of Narcotics: Natural, Semisynthetic,
and Synthetic ................................................. 227
CHAPTER 19
The Pharmacology of Nicotine .................................. 241
CHAPTER 20
The Pharmacology of Nonprescription Medications ................ 249
CHAPTER 21
The Pharmacology of Phencyclidine ............................. 259
CHAPTER 22
The Pharmacology of Sedatives/Hypnotics ........................ 265
CHAPTER 23
The Pharmacology of Interactions Between Medical
and Psychiatric Drugs ......................................... 279
CHAPTER 24
The Pharmacology of Drug Testing: Indications and Methodology ... 291
CHAPTER 25
The Pharmacological Treatment of the Acute Intoxication and
Detoxification of Alcohol and Drugs of Abuse and Addiction ........ 307
CHAPTER 26
The Pharmacology of Abstinence ................................ 327
Contents xi
CHAPTER 27
The Nonpharmacological Treatment of Abuse and Addiction to
Alcohol and Drugs ............................................ 335
CHAPTER 28
The Prevention of Abuse and Addiction to Alcohol and Drugs ....... 345
Index ....................................................... 351
CHAPTER 1
Introduction to the Pharmacological
Effects of Alcohol and Drugs and
Addiction on the Brain and Behavior
History
The course of one drug addiction is significantly affected by the addiction to
another drug or alcohol. It is clinically acknowledged that the course of
alcoholism is often significantly altered by the addiction to another drug.
From the histories of many alcoholics, interestingly, comes the comment
that the course of the alcoholism could have continued if addiction to
cocaine or opiates or sedatives had not developed. Review of the histories
and clinical presentations strongly suggests that this is likely the case, as in
many instances the development of an addiction to another drug motivated
an earlier seeking of treatment in spite of a substantial, standing addiction
to alcohol that had already existed with significant consequences.
Prevalence and Patterns of Use
The identification of multiple drug addictions is critical to clinical diagno
sis, prognosis, and treatment, as well as formulation of research models for
the etiology, of abuse and addiction to alcohol and drugs. The theoretical
implications for the genetic vulnerability and transmission of both alcohol
ism and drug addiction are interesting and far reaching. The traditional
understanding of the neurobiology of addiction to individual drugs is chal
lenged by the concept of multiple addiction, which suggests a universal
susceptibility to alcohol and drug addictions.
The contemporary alcoholic usually becomes addicted to alcohol as the
first drug, but progresses to other drug addictions at a rapid rate and to a
significant degree. Most alcoholics under the age of 30 years are addicted to
at least one other and more often to many drugs. The addiction to the other
drugs is frequently followed by consequences similar to those of the alcohol
addiction. Furthermore, the multiplicity of drugs to which addiction devel
ops is not limited to the alcoholic, that is, most drug addicts who first
become addicted to a drug later develop alcohol addiction, or alcohol may
2 Chapter 1
be the first drug used addictively for many drug addicts. Moreover, although
alcohol is not usually the drug of choice for the drug addict it is used
addictively as an adjunct with a drug or in substitution of a drug (1).
The number and variety of drugs that the multiple addicted seek has
become increasingly extensive. In addition, the traditional boundaries of
addictive use of illicit drugs and the therapeutic use of prescribed medica
tions are considerably less distinct. The nonmedical use of medical drugs
such as benzodiazepines and amphetamines by drug addicts is widespread.
The pure drug addict who is addicted to only one drug is a rare species; it is
difficult to find a heroin addict who is not or has not also been addicted to
marijuana and/or alcohol, and more recently to cocaine. The common prac
tice of adulteration (mixing during preparation) of one illicit drug with
another drug makes it difficult and at times impossible for the addict to
determine and maintain a monodrug addiction, particularly when the drugs
are obtained "on the street."
The effect on personality development and on the manifestation of psy
chiatric symptoms in the personality by the use of multiple drugs is a poorly
documented area of research. Although it is a frequent clinical observation
that the multiple drug addict has greater personality disturbances than the
mono drug addict, the impact on the personality by alcohol and multiple
drugs has not been measured by any standardized method. The contempo
rary alcoholic and drug addict becomes addicted usually sometime in ado
lescence when the personality is developing and when no definite stability or
maturity has been established. The result is often a mixture of alcoholism,
drug addiction, and an immature personality. The salient clinical observa
tion is that the personality undergoes an arrest of maturation in personality
with the onset of addiction.
A source of the manifestations of the personality disturbances is the
pharmacological effects of drugs on the brain and behavior. Alcohol, mari
juana, cocaine, opiates, sedative/hypnotics, and other drugs produce signs
and symptoms of drug intoxication and withdrawal that include disturb
ances in mood, cognition, and vegetative states. These psychoactive effects
on the brain and behavior are often chronic an'd cumulative in the multiple
addicted. The degree of personality disorganization is sometimes marked in
the multiple addicted because of the chronic addiction to multiple drugs
(2,3).
Diagnosis
Because denial is a part of the addictive process, an underreporting and
underestimation of drug use are to be expected in a clinical interview, espe
cially if only the alcoholic is interviewed. Corroborative sources increase the
likelihood of obtaining a more accurate history but still may not reveal the
total pattern and amount of alcohol and drug use. These sources may