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 Drug Use and Abuse, 7th Edition © 2015, 2011 Cengage Learning
Stephen A. Maisto, Mark Galizio,
WCN: 02-200-203
and Gerard J. Connors
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 To Don Atito
S. A. M.

To Audrienne, Kate, and Annie

M. G.

To Lana
G. J. C.

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ABoUt thE AUthoRS

Stephen A. Maisto Mark Galizio Gerard J. Connors

received a PhD in experimental received his PhD in experi- is a senior research scientist
psychology from the University of mental psychology in 1976, at the Research Institute on
Wisconsin—Milwaukee and from the University of Addictions at the University
completed a postdoctoral Wisconsin—Milwaukee, at Buffalo. He earned his
respecialization in clinical psychol- where he served as a doctoral degree in clinical
ogy from George Peabody research assistant at the psychology from Vanderbilt
College of Vanderbilt University. Midwest Institute for University in 1980. Dr.
He is a professor of psychology at Addiction. He is professor of Connors’s research interests
Syracuse University. He has been psychology at the University include substance use and
engaged in research, teaching, of North Carolina abuse, relapse prevention,
clinical practice, and clinical Wilmington, where he has self-help group involve-
training in the assessment and taught and conducted ment, early interventions
treatment of the substance use research for over 30 years. with heavy drinkers, and
disorders for over 30 years. He has published extensively treatment evaluation. He is
Dr. Maisto has published over in the areas of behavioral a fellow of the American
225 articles, 30 book chapters, pharmacology and behavior Psychological Association
and several books on substance analysis and has served as (Divisions of Clinical
use and the substance use associate editor of the Psychology and Addictions).
disorders. His current research is Journal of the Experimental Dr. Connors has authored
supported by the National Analysis of Behavior. His or coauthored numerous
Institute on Alcohol Abuse and research has been supported scientific articles, books, and
Alcoholism and the Department by grants from the National book chapters. His current
of Veterans Affairs. Dr. Maisto is a Institute for Addiction, the research activities are
member of the American National Institute of Neuro- funded by grants from the
Psychological Association (Fellow, logical Disorders and Stroke, National Institute on Alcohol
Divisions of Clinical Psychology and the National Science Abuse and Alcoholism.
and Addictive Behaviors), Associa- Foundation. He is a fellow of
tion for Psychological Science, the American Psychological
Research Society on Alcoholism, Association (Divisions of
and the Association for Behav- Psychopharmacology and
ioral and Cognitive Therapies. Substance Abuse, Behavior
Dr. Maisto was appointed editor Analysis, Behavioral Neuro-
for Psychology of Addictive science and Comparative
Behaviors, a journal published by Psychology, and Experimen-
the American Psychological tal Psychology) and is past
Association, for the term January president of the Division of
1, 2008 to December 31, 2013. Behavior Analysis.
iv

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 BRiEF CoNtENtS

Preface xi

chaPter 1 Drug Use and Abuse 1

chaPter 2 Drug Use: Yesterday and today 23

chaPter 3 Drugs and the Nervous System 45

chaPter 4 Pharmacology 67

chaPter 5 Psychopharmacology and New Drug Development 93

chaPter 6 Cocaine, Amphetamines, and Related Stimulants 118

chaPter 7 Nicotine 144

chaPter 8 Caffeine 173

chaPter 9 Alcohol 193

chaPter 10 opiates 237

chaPter 11 Marijuana 258

chaPter 12 hallucinogens 288

chaPter 13 Psychotherapeutic Medications 315

chaPter 14 other Prescription and over-the-Counter Drugs 354

chaPter 15 treatment of Substance Use Disorders 375

chaPter 16 Prevention of Substance Abuse 417

Glossary 441

references 448

Index 484

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CoNtENtS

Preface xi ch a P t er 3
Drugs and the
Nervous System 45
ch a P t er 1
the Neuron 46
Drug Use and Abuse 1
Neural transmission 47
Pharmacology and Drugs 3
drug classification 4 Drugs and Neural transmission 50
the drug experience 5
Major Neurotransmitter Systems 52
Alcohol and Drug Use in the United States 6 acetylcholine 52
national household survey 7 Monoamines 54
summary of survey data 10 endorphins 56
Multiple drug Use 10 amino acid neurotransmitters 56
International comparisons of drug Use 11 other transmitters 56
negative consequences of alcohol
the Nervous System 56
and drug Use 12
the Brain 58
Defining harmful Drug Use 13 the hindbrain 58
Use of the dsM 13
the Midbrain 59
drug tolerance, Withdrawal, and drug-taking
the forebrain 59
Behavior 17
Imaging the human Brain 62
overview of the text 18 Summary 64
Evaluating Websites 19
Summary 20

ch a P t er 4
ch a P t er 2 Pharmacology 67
Drug Use: Yesterday Pharmacokinetics 69
and Today 23 drug dose 69
routes of administration 70
historical overview 24 drug absorption 74
drug Use in the United states 26 drug distribution 77
Medical science and drug Use 30 drug elimination 77
Development of Drug Laws 31 Summary 81
the san francisco ordinance 32
Pure food and drug act 32
Pharmacodynamics 82
the dose-effect curve 82
harrison narcotics tax act 32
effective and lethal doses 86
alcohol Prohibition 33
drug Interactions 87
Post-Prohibition legislation 35
Summary 90
Current Drug Laws 36
Summary 41

vi

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 contents vii

ch a P t er 5 Effects of Chronic Use 137

Psychopharmacology tolerance 137
dependence 138
and New Drug Stimulant Drugs and ADhD 138
Development 93
Summary 142
Characteristics of Users 94
Biological characteristics 94
Psychological characteristics 95
Social and Environmental Factors 98 ch a P t er 7

tolerance 99 Nicotine 144

types of tolerance 99 history of tobacco Use 146
explanations of tolerance 100 the West discovers tobacco 146
tobacco as Panacea 147
Behavioral Pharmacology 103
from Panacea to Panned 147
reinforcement and Punishment 104
operant Principles and drug dependence 105 Prevalence of tobacco Use 148
drug discrimination 106 smoking in the United states 148
conflict Paradigm 107 Initiation of smoking 150
smokeless tobacco Use 151
Animal Models and human Drug Use 107
Pharmacology of Nicotine 151
human Behavioral Pharmacology 108
sites of action 151
ethical Issues 108
Pharmacokinetics 152
Placebo controls 108
distribution 153
New Drug Development 110 Metabolism and excretion 153
clinical trials and fda approval 111
distribution and Marketing 112
tolerance and Dependence 154
tolerance 154
Generic drugs 113
Physical dependence 154
Summary 115
Acute Effects of Nicotine 155
nicotine’s dependence liability 156
Effects of Chronic tobacco Use 157
ch a P t er 6 tar, nicotine, and carbon Monoxide 159
Cocaine, Amphetamines, diseases linked to cigarette smoking 160
other tobacco Products and health 161
and Related Stimulants 118 Passive smoking 161
the Coca Leaf 119 treatment of Cigarette Smoking 163
Early Use of Cocaine 121 the necessity of formal treatment 164
treatment effectiveness 165
the Amphetamines 123 conclusions about the treatment of cigarette
smoking 167
Cocaine Epidemic ii 124
Summary 170
the Return of Meth 129
Bath Salts 131
Pharmacokinetics of Stimulants 132
ch a P t er 8
Mechanism of Stimulant Action 132 Caffeine 173
Acute Effects at Low and Moderate Doses 134
Sources of Caffeine 174
Physiological effects 134
Behavioral effects 134 history of Caffeine Use 176
Acute Effects at high Doses 136 Prevalence of Caffeine Consumption 177

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 viii contents

Pharmacology of Caffeine 180 fetal alcohol syndrome 227

sites of action 180 Moderate drinking and health 228
Pharmacokinetics 180
the Development of Alcohol Use Disorder 230
tolerance and Dependence 181 traditional approaches to etiology 230
caffeine Withdrawal 181 “Biopsychosocial” approaches to etiology 232
tolerance 181
Summary 233
Acute Effects of Caffeine 182
Behavioral and Psychological effects 182
Interactions among caffeine, nicotine, ch a P t er 10
and alcohol 183
acute toxic effects of caffeine 185 Opiates 237
Chronic Effects of Caffeine Use 187 history of the opiates 238
early history 239
therapeutic Uses of Caffeine 189 opiate Use in the 19th century 239
Conclusions 190 opiate Use in the 20th century and today 241
Prescription opiate abuse 246
Summary 190
Pharmacokinetics 247
absorption 247
distribution, Metabolism, and excretion 248
Mechanisms of opiate Action 248
ch a P t er 9
discovery of endorphins 248
Alcohol 193 What do endorphins do? 249
Alcoholic Beverages 194 Medical Use of opiate Drugs 249
fermentation and distillation 194
expressing the alcohol content of a Beverage 196
Acute Psychological and Physiological
Effects of opiates 252
history of Alcohol Use 197
Chronic Effects of opiates 254
Consumption of Alcohol and heavy tolerance 254
Drinking in the United States 199 Withdrawal and dependence 255
Per capita consumption 199
consumption of alcohol and heavy drinking
Summary 256
among college students 202
Pharmacology of Alcohol 204
ch a P t er 11
sites of action 204
Pharmacokinetics of alcohol 204 Marijuana 258
tolerance and Dependence 209 historical overview 260
tolerance 209 cannabis in the new World 261
Physical dependence 210 committee reports on Marijuana 264
therapeutic Uses 211 Epidemiology 265
Acute Effects of Alcohol 211 Methods of Use 269
Physiological effects 212
Active ingredients 269
sensorimotor effects 214
Potency of cannabis 269
alcohol and driving ability 215
Psychological effects 217 Pharmacokinetics 270
alcohol and Behavior 217 absorption 270
distribution, Metabolism, and excretion 270
Effects of Chronic heavy Drinking 222
alcohol and Brain functioning 224 Mechanisms of Action 271
alcohol and the liver 225 research findings 271
alcohol and reproductive functioning 226 tolerance and dependence 272

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 contents ix

Medical and Psychotherapeutic Uses 273 ch a P t er 13

history of therapeutic Use 273
nausea and Vomiting 274
Psychotherapeutic
cachexia 276 Medications 315
Glaucoma 276
historical overview 317
other Uses 276
the Pre-chlorpromazine era 317
Physiological Effects 277 the age of chlorpromazine 318
acute effects 277
Epidemiology 319
longer-term effects 277
Classes of Drugs and their Actions 321
Psychological Effects 279 antipsychotics 321
Behavioral effects 280
antidepressants 326
cognitive effects 281
antianxiety agents 333
emotional effects 282
nonbenzodiazepine treatment 345
social and environmental effects 283
Mood-stabilizing drugs 347
Summary 284 Psychotherapeutic Drugs and Pregnancy 349
Summary 349

ch a P t er 12 ch a P t er 14
Hallucinogens 288 Other Prescription and
overview 289 Over-the-Counter Drugs 354
Serotonergic hallucinogens: overview 355
LSD and Related Compounds 290 Prescription Drugs 355
early history 291
Birth control drugs 355
recent history 293
anabolic steroids 358
Mechanisms of action of lsd-like drugs 297
Pharmacokinetics of lsd-like drugs 297 over-the-Counter Drugs 362
Psychotherapeutic Uses 298 fda classification 363
effects of serotonergic hallucinogens 299 analgesics 363
adverse effects of serotonergic cold and allergy Medications 365
hallucinogens 300 over-the-counter stimulants and sedatives 365
Methylated Amphetamines 302 herbal Products, hormones, and Dietary
overview 302 Supplements 366
history and epidemiology 304 areca (Betel) 367
effects of Methylated amphetamines 305 dhea 367
toxicity 307 ephedra/Ma huang 367
residual effects of MdMa 307 Ginkgo Biloba 367
Kava 368
Anticholinergic hallucinogens 309
Melatonin 368
Dissociative Anesthetic hallucinogens 310 s-adenosyl-Methionine 369
history 310 st. John’s Wort 369
Pharmacokinetics 310 Valerian 369
effects of PcP and Ketamine 311 Gamma hydroxybutyrate 369
Salvinorin A (Salvia) 312 inhalants 370
Summary 312 Summary 372

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 x contents

ch a P t er 15 Models of Causes and treatment

Treatment of Substance Use Methods 409

Disorders 375 Economic Factors in Alcohol and Drug

treatment 410
Motivation to Change 377
the Stepped Care Approach 411
Change without Formal treatment 378
Summary 413
Self-help Groups 379
alcoholics anonymous 380
other self-help Groups 382
Models of Substance Use Disorders 384
five Model categories 384
Biopsychosocial Model 386 ch a P t er 16
Professional treatment: Assessment Prevention of Substance
and Goals 386 Abuse 417
abstinence or Moderation? 387
harm reduction 388 Defining Prevention 419

Alcohol treatment Settings and Services 388 Models of Prevention 420

types of settings and services 388 sociocultural Model 420
Pharmacological treatment 391 distribution of consumption Model 422
effectiveness of alcohol treatment 392 Proscriptive Model 423
nonpharmacological Professional treatment 393 Principles of Drug Abuse Prevention 424
self-help treatment 394
effectiveness of Pharmacological treatments 396 Current topics in Prevention 427
education and Mass Media efforts 428
other Drug treatment Settings and affect-oriented Programs 431
Services 398 alternative Behaviors and resistance-skills
treatment of nonopiate drug abusers 398 training 431
Pharmacotherapy of other drug Problems 399 Worksite Programs 433
effectiveness of drug treatment 401 Programs for college students 434
nonpharmacological Professional treatment 401
self-help treatment 402 Closing Comments on Prevention 437
Pharmacological treatments 403 Summary 438
Promising treatment techniques 404
Special topics in Alcohol and Drug G lossa ry 441
treatment 405
treatment of Polysubstance abusers 405 r efer en ce s 448
treatment of dual-diagnosis Patients 406
relapse 407 Index 484

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 PREFACE

We began writing the first edition of this text in the late 1980s. At that time, drug
use and related problems were of major interest and concern in the United States and
in other countries. Awareness, interest, and concern about drug use have not abated
since that time, nor has the need for a general undergraduate text to educate college
students on the biological, psychological, and social factors that influence drug use
and its effects. Therefore, we have completed this seventh edition, which retains
many features of previous editions but also reflects changes that have occurred in this
very dynamic area of study since the sixth edition was published in 2011.
As in all of the text’s previous editions, the central theme of this edition is that a
drug’s effects are determined not only by its chemical structure and interaction in the
body but also by drug users’ biological and psychological characteristics and the set-
ting in which they use the drug. This central theme is reflected in the inclusion of
chapters on pharmacology and psychopharmacology, and is continued throughout
the presentation of individual drugs or drug classes and in the discussion of preven-
tion and treatment. The text examines the complexity of human drug consumption
on biological, psychological, and social levels. Although the text is scholarly, it is
understandable to students with little background in the biological, behavioral, or
social sciences.
The text also retains a number of pedagogical features designed to increase stu-
dents’ interest and learning. Diagnostic pretests at the beginning of each chapter
challenge students to test their knowledge of drugs while drawing their attention
to important concepts or facts that follow in the chapter. Pretest answers and expla-
nations at the end of each chapter provide an important review of the main con-
cepts. The margin glossary helps students identify and define important terms
within the text. Margin quotes help bring abstract concepts to life through per-
sonal accounts, comments, and quips about drug use and its ramifications. Drugs
and Culture boxes explore variations in drug use and its consequences. They high-
light the importance of differences in drug use that are associated with factors such
as a person’s sex, race, and ethnic background. Finally, Contemporary Issue boxes
discuss current controversies involving drugs or drug use, as well as events related
to such controversies.

New in this Edition

As mentioned earlier, drugs and drug use are popular and dynamic areas of study. For
example, when the sixth edition was published in 2011, synthetic designer drugs like
“Spice” and “bath salts” had not yet emerged as international phenomena. These
designer drugs are sold on the Internet, often legally. The seventh edition chronicles
the impact of this drug trade, with a focus on the legal changes in the United States
designed to address the problem (Synthetic Drug Abuse Prevention Act of 2012,
Chapter 2) and reviews of the major drugs involved: synthetic cathinones or bath salts
(Chapter 6), synthetic cannabinoids or Spice (Chapter 11), and phenethylamine hal-
lucinogens (2C-B, Chapter 12).
Numerous other changes have occurred in the field since publication of the sixth
edition. Each chapter of the seventh edition has been updated to represent findings
from the latest research, as well as to reflect social and legal changes related to drugs.

xi

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xii Preface

Among the many revisions, we present the latest survey data available at this writing
on patterns of drug use in the United States and in other countries worldwide. We
also align the seventh edition where relevant with the recently published fifth edition
of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Chapter 2, “Drug Use: Yesterday and Today,” includes new information on the
voter approvals—in Colorado and Washington—to regulate, tax, and control
marijuana in a manner similar to that applied to alcohol, updates on the continu-
ing movement to legalize the use of marijuana for medical reasons, updated mate-
rial on drug legislation, including the 2010 Fair Sentencing Act and the 2012
Synthetic Drug Abuse Prevention Act, and new coverage on “bath salts” and
synthetic marijuana.
Chapter 3, “Drugs and the Nervous System,” adds detail on neurotransmission
processes, receptors, and receptor subtypes.
Chapter 6, “Cocaine, Amphetamines, and Related Stimulants,” adds new sections
on the crack sentencing law controversy and on regulations on methamphetamine
and the effects of such regulation on the production and availability of methamphet-
amine. Chapter 6 also contains a new Drugs and Culture box on the current use of
coca in Latin America, as well as updates on the epidemiology of cocaine and meth-
amphetamine use.
Chapter 7, “Nicotine,” has updated National Survey on Drug Use and Health
(NSDUH) data on the epidemiology of nicotine use in the United States, along with
an expanded and updated section on the treatment of nicotine addiction. Chapter 7
also features updated material on the harm-reduction approach to cigarette smoking,
including discussion of products billed as “safer” alternatives to traditional cigarettes,
such as the electronic cigarette and smokeless tobacco products.
Chapter 8, “Caffeine,” includes the latest data on caffeine effects, including a va-
riety of apparent health benefits of coffee, and updates on caffeine consumption
among children. The latest information on the combined use of alcohol and caffeine
is also provided.
Chapter 9, “Alcohol,” has new epidemiological data on alcohol consumption in
the United States and around the world, as well as the health “benefits” of moderate
alcohol consumption. Chapter 9 also contains updated data on the effects of a preg-
nant woman’s moderate alcohol use on the health of the fetus that she is carrying.
Chapter 10, “Opiates,” includes an updated discussion of prescription opiate
drug abuse.
The chapter on marijuana (Chapter 11) includes the latest epidemiological data on
marijuana use around the world, including use among youth. Chapter 11 also con-
tains the latest information on the therapeutic uses of marijuana, on the relationship
between cannabis use and various mental health outcomes, and on the increased risk
of a motor vehicle crash when under the influence of cannabis. The chapter also in-
cludes a new Contemporary Issue box on synthetic marijuana, best recognized under
the names of Spice and K2, among others.
Chapter 12, on the hallucinogens, includes new information on therapeutic uses
of hallucinogen drugs, including MDMA for post-traumatic stress disorder and ket-
amine for depression, as well as coverage of DMT.
Chapter 13, “Psychotherapeutic Medications,” includes the latest information on
newly prescribed psychotherapeutic medications, with discussion of their benefits
and side effects. Chapter 13 also includes a newly developed section on the use of
psychotherapeutic medications during pregnancy, which often has been a difficult
and challenging issue for pregnant women and their physicians alike.

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 Preface xiii

Chapter 14, “Other Prescription and Over-the-Counter Drugs,” has dropped cov-
erage of the compound salvia that is now covered in Chapter 12. In addition, Chapter
14 covers the new continuous birth control pill and includes an update on the health
risks associated with acetaminophen.
Chapter 15, “Treatment of Substance Use Disorders,” includes new information
on the use of technology (e.g., computer-delivered, mobile device-delivered) inter-
ventions, integration of the Affordable Care Act in our discussion of economics and
the stepped-care approach to substance use disorders treatment, as well as discussion
of 12-step facilitation treatment.
Chapter 16, “Prevention of Substance Abuse,” covers the latest trends in preven-
tion interventions, including programs geared toward college students. Updates on
the broad array of negative consequences associated with problematic use of alcohol
among college students, including deaths, injuries, sexual abuse, and academic prob-
lems, are provided.
Accompanying the seventh edition are both new and expanded supplements that
will help instructors with class preparation and help students by providing opportu-
nities for review. In the Instructor’s Manual with Test Bank, we provide chapter
outlines, learning objectives, InfoTrac® College Edition, key terms, glossary terms
and definitions, useful web links, and test items in three formats (multiple-choice,
true/false, and essay).
The test bank is also available in Cognero electronic format, which allows instruc-
tors to author, edit, and manage test bank content from multiple Cengage Learning
solutions. The new companion website offers text-specific, interactive review and en-
richment materials for students, including tutorial quizzes, flash cards, and useful
web links. Electronic transparencies found on the instructor companion website pro-
vide figures and tables from the seventh edition uploaded into Microsoft PowerPoint
that instructors can use as is or modify to create their own presentations. Each new
copy of the seventh edition comes with a pass code to the InfoTrac College Edition
full-text periodical database. With this database, students will have access to thou-
sands of journal articles from a wide variety of publications.

Acknowledgments
This text could not have been completed without the help of a number of people.
Foremost among these individuals are Jon-David Hague, product director; Amelia
Blevins, product assistant; Joshua Taylor, outsource development coordinator; Charlene
Carpentier, content project manager; and Vernon Boes, senior art director. Thanks
also go to the production team, including Heather McElwain, copy editor; Alekha
Jena, proofreader; Shan Young, indexer; and Teresa Christie, production editor at
MPS Limited. Thank you as well to the composition team at MPS Limited, led
by Rakesh Pandey.
Many thanks also go to those who contributed time and energy to reviewing our
manuscript. The following reviewers offered outstanding suggestions that helped us
to produce a better book: Deborah A. Carroll, Southern Connecticut State Univer-
sity; Bradley Donohue, University of Nevada—Las Vegas; Yousef Fahoum, MAP,
University of Arkansas at Little Rock/Benton; Charles R. Geist, University of the
Virgin Islands; Marc Gellman, University of Miami; Barry Goetz, Western Michigan
University; Ruth Kershner, West Virginia University; Jim Kirby, Fresno City College;
Cheryl Kirstein, University of South Florida; Marvin Krank, Okanagan University
College; Jerry Lundgren, Flathead Valley Community College; Don Matlosz,
California State University—Fresno; Rustem Medora, University of Montana;

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xiv Preface

Bill Meil, Indiana University of Pennsylvania; Kelly Mosel-Talavera, Texas State Uni-
versity; Rob Mowrer, Angelo State University; Michelle L. Pilati, Rio Hondo
College; and Joseph Vlah, Flagler College. We also extend special thanks to Lynn
Ingram, University of North Carolina Wilmington, for her many helpful comments
and suggestions for this seventh edition.
We also want to thank other special people who helped us in completing the sev-
enth edition. Stephen Maisto would like to thank his wife, Mary Jean Byrne-Maisto,
for her love and support in finishing this edition, particularly in the last year. He
also would like to thank his two outstanding graduate students, Todd Bishop and
Marketa Krenek, for all of their help in preparing this edition. Mark Galizio thanks
his wife, Kate Bruce, and daughter, Annie. Their love and support make it all worth-
while. Mark also thanks the many students at the University of North Carolina
Wilmington who provide continuing challenges and inspiration. Gerard Connors
thanks his wife, Lana Michaels Connors, for her constant support and love through-
out the preparation of the seventh edition. Gerard also thanks Mark R. Duerr and
Michael Maher for their tireless assistance and patience in preparing the chapters for
this edition.
Stephen A. Maisto
Mark Galizio
Gerard J. Connors

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 Chapter ONe

Drug Use and abuse

Pharmacology and Drugs Defining Harmful Drug Use
Drug Classification Use of the DSM
The Drug Experience Drug Tolerance, Withdrawal, and
Drug-Taking Behavior
Alcohol and Drug Use in the
United States Overview of the Text
National Household Survey Evaluating Websites
Summary of Survey Data
Multiple Drug Use Summary
International Comparisons of Drug Use
Negative Consequences of Alcohol
and Drug Use

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 2 Chapter One

What Do You Think? True or False?

Answers are given at the end of the chapter.
___ 1. Because the effects of drugs are both pre- ___ 8. The total economic cost of alcohol and
dictable and obvious, it is relatively easy to drug abuse in the United States is about a
define drug abuse. billion dollars annually.
___ 2. A drug’s street name sometimes describes ___ 9. The use of alcohol and other drugs causes
the actual effect of that drug. violence and crime.
___ 3. A person’s reaction to a drug depends ___10. Modern researchers rely on definitions of
mostly on the biological action of the drug alcohol and other drug use that are free of
in the body. social or cultural biases.
___ 4. Because drug use is complicated, it is im- ___11. A diagnosis of drug use disorder is made
possible to estimate patterns of drug use for when a person has become either physically
the population of a whole country. or psychologically dependent on a drug.
___ 5. Within the United States, similar patterns of ___12. Definitions of addiction emphasize over-
alcohol and other drug use are found even whelming involvement with a drug.
among different subgroups of the population.
___13. The continued use of any drug will eventu-
___ 6. The highest rates of alcohol and other drug ally lead to tolerance of and physical depen-
use are found among 18- to 25-year-olds. dence on that drug.
___ 7. A person’s use of more than one drug at a
time is of little concern because it happens
so infrequently.

Athletic Legal Religious

Biological Medical Social/cultural
Economic Political
Educational Psychological

Q: How are these 10 systems alike?

A: They influence or are influenced by alcohol and other drug use.
This one-question quiz shows that drugs1 may affect us in many ways, whether or not we
use them. Although what we see and hear in the media often focuses on the negative
consequences of drug use, drugs are popular all over the world because people perceive
that they benefit from using drugs. For example, on an individual level, people say that
drugs make them feel more relaxed, socialize more easily, feel sexier, escape boredom, and
feel more confident and assertive. Drugs have also helped to ease a lot of suffering in hu-
mans and other animals when used for specific medical purposes. On a group or community
level, drugs have been used for thousands of years as part of social and religious rituals.
Drugs are used for such purposes less for the effects of the drug’s chemistry than for social
or cultural reasons. One society may condone the use of a drug—say, alcohol in the
United States and European countries—whereas another society condemns it, such as the

1
Sometimes in this book, we use the phrase alcohol and drugs; at other times, we use drugs as the inclusive
term. Because alcohol is a drug, saying “alcohol and drugs” is redundant. However, we do so on occasion,
when it seems useful, to distinguish alcohol from all other drugs.

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 Drug Use and Abuse 3

Islamic countries of Iran and Saudi Arabia. This complex picture of human drug use sug-
gests that many different factors influence drug use.
What influences drug use and how that use affects us make up the subject of drugs
and human behavior and are what this text is about. Because our subject matter is so
wide-ranging, this introductory chapter spans a variety of topics. We include formal
definitions throughout the chapter, beginning with terms such as pharmacology, drug,
and drug abuse.
Introducing a lot of terms in one chapter might be confusing at first, but there is no
need to feel that you have to grasp all the terms immediately. Because the terms will be “Food is good. Poison is
bad. Drugs may be good
used repeatedly throughout the book, you will have time to learn them. By introduc- or bad, and whether they
ing the terms now, we give you the vocabulary to read later chapters more easily. are seen as good or bad
In this chapter, we also explain the drug-classification systems used in this book and depends on who is looking
at them.”
then move to a discussion of who uses drugs. The final sections of the chapter cover
(Weil & Rosen,
ways to define harmful drug use. The chapter closes with a brief overview of the rest of 1983, p. 10)
the text.

pharmacology and Drugs

Humans have used drugs for several thousand years, but the scientific study of drugs is
more recent. The scientific study of drugs is called pharmacology, which is concerned pharmacology
The scientific study of drugs
with all information about the effects of chemical substances (drugs) on living systems. concerned with all
Pharmacology is considered a part of biology and is allied with physiology and bio- information about the
effects of drugs on living
chemistry (Blum, 1984). Psychopharmacology is an area within the field of pharma- systems.
cology that focuses on the effects of drugs on behavior. Although psychopharmacology psychopharmacology
is a joining of the words psychology and pharmacology, it is now recognized that under- The subarea of pharmacol-
ogy that concerns the
standing how drugs affect human behavior requires knowledge about social and envi- effects of drugs on
ronmental factors as well. This book is about human psychopharmacology. behavior.
Drugs are easy enough to talk about, or so it seems from the numbers and variety psychology
The scientific study of
of people who do so. However, defining drug is not so simple. Although they have run behavior.
into confusion along the way, experts have arrived at a workable definition. According drug
to a World Health Organization (WHO) report published in 1981, drug is defined in Broadly defined as any
chemical entity or mixture
the broadest sense as “any chemical entity or mixture of entities, other than those re- of entities not required for
quired for the maintenance of normal health (like food), the administration of which the maintenance of health
but that alters biological
alters biological function and possibly structure” (p. 227). This definition remains use- function or structure when
ful today (United Nations Office on Drugs and Crime, 2003). administered.
These fundamental definitions bring us to the questions: What is drug use, and what
is drug abuse? We discuss these distinctions in more detail later in this chapter, but it is
important for you to get an idea at the outset of what is called drug use and drug
abuse. Abuse has been referred to in different ways when people write about drugs,
and there is no generally accepted definition. In such circumstances, one way to define
a term is by a consensus of experts. A study by Rinaldi et al. (1988) achieved such a
consensus definition for a number of terms used in research and clinical work on alco-
hol and drugs. In the Rinaldi et al. study, the experts defined drug abuse as “any use drug abuse
Any use of drugs that causes
of drugs that causes physical, psychological, legal, or social harm to the individual or physical, psychological,
to others affected by the drug user’s behavior.” legal, or social harm to the
individual user or to others
As you can see, the definition of abuse centers on the consequences of drug users’ affected by the drug user’s
behavior, both to themselves and to others in their social environment. Our opening behavior.
question on the 10 systems and drug use comes into sharper relief with this definition
of abuse. The definition also illustrates the difficulties in defining abuse. A major

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
 4 Chapter One

problem is that the behavior that causes consequences in one community or culture
may not cause them in another, or not to the same degree. Therefore, the goal to have
a standard reference for drug abuse has proved elusive. Nevertheless, in writing and
other forms of communication about alcohol and other drugs, the word abuse is used
frequently, and thus efforts to arrive at a more generally applicable definition should
continue. For now, however, our initial definition of abuse is sufficient for understand-
ing what we say in the first part of this chapter. Toward the end of this chapter, we
discuss a “diagnostic” definition of substance (alcohol or other drugs) abuse that the
American Psychiatric Association has developed.
If abuse is drug use with negative consequences, then drug use may be viewed as the
larger category, with drug abuse as a subset. Drug consumption that does not meet the
criteria for drug abuse is referred to as drug use.

Drug Classification
As the WHO panel of experts understood, their definition of drug is very broad. To
make the definition useful for research and practical purposes, it is necessary to order
the substances that fit the definition of drug into smaller categories. Pharmacol-
ogists have done this with their many systems for classifying drugs. These classifica-
tion systems have been based on the primary properties of drugs to communicate a
drug’s nature and the ways it can be used. Following are some of the major ways of
classifying drugs:
1. By origin. An example is drugs that come from plants, such as the opiates, which are
derived from the opium poppy. The “pure” (nonsynthetic) opiates include com-
pounds such as morphine and codeine. Heroin, which is a semisynthetic compound,
is often called an opiate drug. Because this classification distinguishes only the
source of the drug, a given drug class may include many drugs that have different
chemical actions.
2. By therapeutic use, or according to similarity in how a drug is used to treat or
modify something in the body. For example, with this system, amphetamines are
called appetite-suppressant drugs. Note that the reasons some drugs are used can be
much different from their therapeutic effects. Amphetamines are often used non-
medically because of their stimulant effects. Similarly, morphine may be used medi-
cally as a powerful painkiller, but street users most commonly take morphine for its
euphoric effects.
3. By site of drug action, which pertains to where in the body the drug is causing
physical changes. For example, alcohol is often called a depressant drug because of
its depressant action on the central nervous system (CNS). Conversely, because
of its CNS stimulant properties, cocaine is often called a stimulant drug. The utility
of this system is limited when a drug affects several different body sites. One ex-
ample is the CNS stimulant cocaine, which also has local anesthetic (pain-reducing)
effects. Furthermore, drugs that differ widely in chemical structure or mechanisms
of action may affect the same body site.
4. By chemical structure. For example, the barbiturates (such as phenobarbital,
Amytal, and Seconal) are synthetic compounds derived from the chemical structure
of barbituric acid, the synthetic compound that forms the chemical base for
barbiturate drugs.
drug effects
The action of a drug on the 5. By mechanism of action, which means how a drug produces its drug effects. This
body. Drug effects are is a good system in principle, and ongoing research in pharmacology is directed at
measured in different ways.
specifying the mechanisms of action of an increasing number of drugs.

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 Drug Use and Abuse 5

6. By street name, which comes from drug “subcultures” and the street drug market.
For example, amphetamines are called “speed,” and drugs like the barbiturates or “I don’t do drugs. I am
drugs.”
depressants such as methaqualone (Quaalude) are called “downers.” As these exam-
Salvador Dali
ples show, street names sometimes reflect actual drug effects. (Brands, Sproule, &
Marshman, 1998, pp. 11–13)
The topics of this text’s drug chapters (Chapters 6 through 14) were determined
according to several different ways of classifying drugs. One of the ways to classify
drugs, by their effects, applies to virtually all of the drugs covered in this text. We are
most interested in psychoactive drugs—those that affect moods, thinking, and behav- psychoactive
Pertaining to effects on
ior. Some substances have been designated formally as psychoactive, such as alcohol, mood, thinking, and
whereas others have not, such as aspirin. Psychoactive drugs are most important in this behavior.
text because they are the ones that people are most likely to use, sometimes in ways
that create serious problems for them. This text mainly concerns the nonmedical use
of psychoactive drugs, but we also discuss medical uses.

the Drug experience

As we said earlier, people like many of the experiences they have when they take drugs.
This raises an important question: What causes the “drug experience”? The drug’s
chemical action is part of the answer, but how much? Not too long ago, the chemical
actions of drugs were viewed as the primary reason people experienced certain changes
when they took different drugs. However, research from different disciplines, such as
pharmacology, psychology, and sociology, has shown that the drug experience is a
product of more factors than just the drug’s pharmacological action.
Generally, we can look at three sets of factors, one pharmacological and two non-
pharmacological. The first set includes pharmacological factors, and three of them
stand out. First are the chemical properties and action on the body of the drug used.
Another is drug dosage (or dose), which is the measure of how much of the drug is drug dosage
Measure of the quantity of
consumed. The third pharmacological factor is the route of drug administration, drug consumed.
or the way the drug enters the body. This is important because the route affects route of drug adminis-
how much of a dosage reaches its site(s) of action and how quickly it gets there. tration
The way that drugs enter
Chapter 4 discusses in detail major routes of drug administration and their effects on the body.
the drug experience.
The second set of factors is nonpharmacological and consists of the characteristics of
the drug user. Included are such factors as the person’s genetic makeup (biologically
inherited differences among people govern their bodies’ reaction to the ingestion of
different drugs), gender, age, drug tolerance, and personality. An important part of
personality is the person’s psychological set about a drug, which refers to knowledge, psychological set
An individual’s knowledge,
attitudes, expectations, and thoughts about a drug. For example, sometimes the strong attitudes, expectations, and
belief that a drug will produce a certain effect will be enough to produce the effect, other thoughts about an
object or event, such as a
even though the person has ingested a chemically inactive substance (placebo). drug.
The third and last set of factors, also a nonpharmacological one, is the setting in placebo
which a drug is used. The factors in this group span a wide range and include laws per- In pharmacology, a
chemically inactive
taining to drug use in the community where the drug is taken, the immediate physical substance.
environment where the drug is used, and whether other people are present at the time
of drug use.
Together, these three sets of factors influence what people experience when they
take a drug. You may have guessed that the path to a drug experience is not always
easy to chart. However, many people are trying to do just that—to understand how
drugs affect people. The accumulated knowledge from these efforts is the foundation
of this book.

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 6 Chapter One

alcohol and Drug Use in the United States

The way the popular media tell it, it may seem as if virtually everyone has positive ex-
periences using drugs because everyone seems to be using them. However, scientists
learned long ago that our impressions or feelings about a subject often are inaccurate,
and to find out what is really going on, it is best to study the subject systematically.
This means using the scientific method, which is the major way we have learned as
“I could have easily gotten
stoned [before coming to much as we do know about drugs. One of the best ways to answer questions about
this interview]; it the uses of alcohol and drugs in a community or larger region is to do a survey
wouldn’t have bothered study. When we want to learn about a whole country, we do what is called a national
me. It depends on the
situation. I wouldn’t like survey study.
to smoke [marijuana] in In the United States, national survey studies of alcohol and drug use have involved
the middle of the day if I interviewing a sample of individuals (in this case, age 12 or older) across the country.
have things to do. Or I
wouldn’t smoke in the Such studies generally ensure that those interviewed are as similar as possible to the
middle of a class. Things U.S. population as a whole—regarding, for example, factors such as gender, age, race,
like that.” region of the country, and rural versus urban living environments. The national survey
Research participant
(Zinberg, 1984, p. 140)
data give us the best estimate we have of what the findings would be if we studied every
person in the population age 12 and older. In the United States, that means about
255 million people.
The U.S. federal government goes to great trouble and expense to support these
national surveys of drug use, because the knowledge gained from them is extremely
valuable in making legal, tax, educational, and health policy decisions. More narrowly,
we are interested in the information from national surveys for this text because many
people do not know the typical patterns of drug use among Americans. For example,
the popular media expose us primarily to extreme cases of use and problems associated
with it. The national survey data on alcohol and drug use give us a more balanced
reference for understanding any one person’s or group’s use. In the same way, our
brief review of national survey data in this chapter will help you understand drug use
patterns and related problems that we write about in later chapters of this book.
Matt Smith/Comstock/Jupiter Images

Corbis

People use drugs in a variety of situations and experience different reactions to them.

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 Drug Use and Abuse 7

ConTemporarY Issue Box 1.1

U.S. Society and Drug Use

Learning about alcohol and drug use in the United screens (tests for drug taking) of employees as a
States is important. One reason is the sheer number of way to control drug abuse in the workplace
people in the United States who use alcohol or other ● The question of whether intravenous drug users
drugs. Another reason is the negative consequences should be supplied with clean syringes free of
associated with alcohol and drug use, which are charge as a way of preventing the spread of
discussed later in more detail. A third reason is the human immunodeficiency virus (HIV) infection
amount of controversy that drugs, especially illicit ● The continuing debate on whether marijuana
drugs, create. Despite the prevalence of drug use should be available as a prescription drug, and
among its citizens, United States popular opinion has more recently, whether it should be legally
been to eradicate illicit drug use, at times ranking such available to adults for recreational purposes
use among the nation’s top problems. Indeed, a 2007 ● Some proposed legal penalties related to selling
survey conducted by the University of Michigan or using drugs—the requirement of life sentences
involved collection of data on adults’ perceptions of for drug dealers who are convicted twice of
the main problems threatening children’s and adoles- selling drugs to teenagers and the imposition of
cents’ well-being, and “drug abuse” was number 2 in the death penalty for dealers when a murder
the top 10. (Interestingly, smoking tobacco and alcohol occurs during a drug deal
abuse were numbers 1 and 4, respectively.) Think of
Many Americans use alcohol or other drugs. How-
some of the major headline events that have occurred
ever, the country’s attitudes toward such use,
and the controversies they have generated in the last
especially regarding illicit drugs, are far from
few years. Some of them touch upon the basic
permissive. Society’s proposed and actual solutions
constitutional rights of Americans:
to drug use in the United States have far-reaching
● The right of the federal government and other legal, social, and financial implications. Which stand
public and private employers to conduct urine out to you?

National household Survey

To provide you with an overview of current alcohol and drug use, we used a national
survey that is conducted annually by the Office of Applied Studies within the Substance
Abuse and Mental Health Services Administration (SAMHSA). The National Survey
on Drug Use and Health (NSDUH) includes households in all 50 U.S. states and the
District of Columbia. In this section, we refer to findings from the 2011 survey
(SAMHSA, 2012).
This survey included individuals 12 years of age or older. Personal and self-
administered interviews were completed with 69,500 respondents. As it was a house-
hold survey, people such as military personnel in military installations, individuals in
long-term hospitals, and prisoners were excluded from the sample. As a result, the data
cannot be viewed as completely representative of everyone in the 50 states. Neverthe-
less, the NSDUH provides the best single description of frequency and quantity of
drug use among a broad age range of people in U.S. society.
prevalence
In the 2011 NSDUH, a variety of data about drug use in the United States were The general occurrence of
collected. We first discuss data on the overall prevalence of use in the last year and the an event, usually expressed
in terms of percentage of
last month respectively for different drugs, including alcohol and tobacco cigarettes. some population. Another
In this case, “use” means the person used the drug in question at least once during the common statistic in survey
studies is incidence, or the
time in question; “past month” and “past year” are from the time the respondents give number of first-time
information about their drug use. We also offer counterpart prevalence data from the occurrences of an event
during some time period.
2010 survey to allow for comparison with the 2011 data. Table 1.1 presents this first

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
8 Chapter One

TAblE 1.1 percentages of Individuals aged 12 and Older Who

reported Use of Drugs for the past Year and past Month,
2010 and 2011
Past Year Past Month
Drug 2010 2011 2010 2011
Marijuana 11.6 11.5 6.9 7.0
Cocaine 1.8 1.5 0.6 0.5
Inhalants 0.8 0.8 0.3 0.2
Hallucinogens 1.8 1.6 0.5 0.4
Heroin 0.2 0.2 0.1 0.1
Nonmedical use of any 6.3 5.7 2.8 2.7
psychotherapeutic
Alcohol 66.4 66.2 51.8 51.8
Cigarettes 27.0 26.1 23.0 22.1
Note: Psychotherapeutic drugs include any prescription-type stimulant, sedative, tranquilizer, or analgesic. They do not include
over-the-counter drugs. “Use” means used at least one time.

Source: SAMHSA (2012).

set of percentages. Several findings stand out in Table 1.1. First, alcohol leads the use
list, followed by cigarettes in a distant second place. Marijuana heads the list of illicit
drug use (drug use not in accord with legal restrictions). These relationships hold up
for use both in the past year and in the past month.
Table 1.1 gives you an overall picture of drug use, but as we noted before, drug use
differs with characteristics of people. Tables 1.2 and 1.3 give you an initial look at some
of the characteristics that are highly associated with drug use differences. Table 1.2
centers on age differences in drug use in the past year and month, as reported in the
2011 national survey. As you can see in Table 1.2, individuals in the age range 18 to
25 have the most prevalent substance use. Over three of every four of these respon-
dents said they used alcohol in the last year, and over one of every three of them re-
ported at least one occasion of illicit drug use in the past year. In Table 1.3, we provide
2011 substance use data for the past month according to ethnic or racial group and
gender. The most striking findings in Table 1.3 are the gender differences. Men were
almost one and three-quarters times as likely as women to report any illicit drug use in

TAblE 1.2 percentages of Individuals in Different age Groups Who

reported Use of Drugs for the past Year and past Month,
2011
Past Year Past Month
Drug 12–17 18–25 $26 12–17 18–25 $26
Any illicit 19.0 35.2 10.8 10.1 21.4 6.3
drug
Alcohol 27.8 77.0 69.1 13.3 60.7 55.1
Cigarettes 13.2 42.3 24.9 7.8 33.5 21.9
Note: Any illicit drug use includes the nonmedical use of marijuana, cocaine, inhalants, hallucinogens, heroin, or
psychotherapeutic drugs at least one time.

Source: SAMHSA (2012).

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.