Substance abuse

Article Abstract:

The public attitude toward drug abuse is punitive, with more than half of the drug control budget for fiscal year 1990 earmarked for law-enforcement efforts (40 percent) and building correctional facilities (20 percent). Less than 12 percent is to be used for improving the quality and capacity of drug abuse treatment. Many politicians and academics, however, regard drug abuse as a public health, not a law enforcement, problem. One suggestion made by this group is to decriminalize drug use to reduce drug traffickers' profits. The current administration is opposed to this approach. Data from hospital emergency departments reveals increased mortality due to illicit drugs (heroin, cocaine, marijuana or hashish, and phencyclidine), but household survey data indicates that recreational use of drugs is decreasing. Cocaine has become less popular with middle-class users, while its smokable form, 'crack', has gained popularity in the inner city. In this setting, crack is associated with increased psychiatric and medical morbidity, AIDS (acquired immunodeficiency syndrome), poverty, and a younger age of addiction. Support systems are lacking, resources are scarce, and the problem is one of 'habilitation', rather than 'rehabilitation'. A newly created Office of Treatment Improvement (Alcohol, Drug Abuse, and Mental Health Administration) may prove to be a positive force. Funds are needed to train health care professionals, especially physicians, in diagnosing and treating addicts. The private sector, unlike the federal government, is beginning to focus on prevention and treatment. The Robert Wood Johnson Foundation has committed more than $24 million to this end. Alcohol, the most widely abused drug in the US, is not part of the national drug policy. Recent developments in the molecular physiology of intoxication are reviewed. Alcohol is often used in conjunction with other drugs, and is a major cause of cirrhosis-related mortality. Possible genetic bases for alcoholism are discussed and the appropriateness of liver transplantation for this population is evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Causes of, Political aspects, Drug treatment centers

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Substance abuse

Article Abstract:

The field of addiction medicine is growing rapidly in the US. In this country, there are about 65 fellowships for physicians leaving their residency training to achieve further advanced training in substance abuse. Recent epidemiological studies have identified a promising trend in high schools and colleges. During the past 10 years, cocaine and marijuana use have fallen on many campuses. The rate of cocaine use dropped sharply after 1986, when the death of promising basketball player Len Bias was followed only weeks later by the death of professional football player Don Rogers. Unfortunately, the overall trend toward reduced cocaine use, particularly ''crack,'' cannot hide the unabated use among disadvantaged people. The study of alcoholism is likely to be benefited by a recent discovery regarding transferrin. Transferrin is a blood protein which carries dietary iron; in its normal state, sugar molecules are chemically bound to the transferrin. Alcoholics seem to have transferrin in their blood that is deficient in these sugars; the biochemical analysis of transferrin may be able to identify 86 percent of alcoholics on the basis of a blood test. A Swedish study on the treatment of heroin addicts has found that methadone maintenance therapy provides an important benefit and helps addicts to recover and become gainfully employed. One major difference between the Swedish and the Americans is that in the United States, methadone is often handed out to addicts without counselling or efforts at resocialization of the addict. In Sweden, the addict is taught social and vocational skills, and receives long-term follow-up care. The successful results save the Swedes expenses in the form of police, prison, and welfare, in addition to cutting the rate of AIDS transmission. (Consumer Summary produced by Reliance Medical Information, Inc.)

Substance abuse

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Addiction medicine

Article Abstract:

Managed care may bring addiction treatment into mainstream medicine, with primary care physicians assuming more responsibility for treating drug addicts. Up until the 1990s, addiction treatment was carried out in specialized treatment clinics, some of which received money from the federal war on drugs. However, managed care is closing down many inpatient treatment centers and will only provide detoxification treatment on an inpatient basis. Flunitrazepam (Rohypnol) is an insomnia drug that is being abused by many addicts. It has received much media attention because it has been used in some incidents of date rape. Pharmaceutical companies continue to develop new drugs to treat chemical dependence. In addition to methadone, levo-alphaacetylmethadol (LAAM) and naltrexone are used to treat opiate addition. Unfortunately, no drug has yet been discovered that can treat cocaine dependency.

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