Drug Use and Abuse 8th Edition
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E I G H T H editi o n
Drug Use
and Abuse
Stephen A. Maisto
Syracuse University
Mark Galizio
University of North Carolina Wilmington
Gerard J. Connors
Research Institute on Addictions, University at Buffalo
Australia • Brazil • Mexico • Singapore • United Kingdom • United States
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Drug Use and Abuse, 8th Edition © 2019, 2015 Cengage Learning, Inc.
Stephen A. Maisto, Mark Galizio,
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Printed in the United States of America
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To Joseph A. Maisto
S. A. M.
To Kate and Annie
M. G.
To Elyse and Guy
G. J. C.
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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.
ABOUT THE AUTHORS
Stephen A. Maisto Mark Galizio Gerard J. Connors
received a PhD in experimental received his PhD in experimental is a senior research scientist at
psychology from the University of psychology in 1976, from the the Research Institute on
Wisconsin—Milwaukee and University of Wisconsin— Addictions at the University at
completed a postdoctoral Milwaukee. He is professor of Buffalo. He earned his doctoral
respecialization in clinical psychology at the University of degree in clinical psychology
psychology from George Peabody North Carolina Wilmington, from Vanderbilt University in
College of Vanderbilt University. where he has taught and 1980. Dr. Connors’s research
He is a professor of psychology at conducted research for over interests include substance use
Syracuse University. He has been 30 years. He has published and abuse, relapse prevention,
engaged in research, teaching, extensively in the areas of self-help group involvement,
clinical practice, and clinical behavioral pharmacology and early interventions with heavy
training in the assessment and behavior analysis and has served drinkers, and treatment
treatment of the substance use as associate editor of the Journal evaluation. He is a member of
disorders for well over 30 years. of the Experimental Analysis of the American Psychological
Dr. Maisto has published over 300 Behavior. His research has been Association (Fellow, Divisions of
articles, 30 book chapters, and supported by grants from the Clinical Psychology and
several books on substance use National Institute on Drug Abuse, Addictive Behaviors), Research
and the substance use disorders. the National Institute of Society on Alcoholism, and
His current research is supported Neurological Disorders and Association for Behavioral and
by the National Institute on Stroke, and the National Science Cognitive Therapies. Dr. Connors
Alcohol Abuse and Alcoholism Foundation. He is a fellow of the has authored or coauthored
and the Department of Veterans Association for Behavior Analysis, numerous scientific articles,
Affairs. Dr. Maisto is a member of International and the American books, and book chapters. His
the American Psychological Psychological Association current research activities are
Association (Fellow, Divisions of (Divisions of Psychopharmacology funded by grants from the
Clinical Psychology and Addictive and Substance Abuse, Behavior National Institute on Alcohol
Behaviors), Association for Analysis, Behavioral Neuroscience Abuse and Alcoholism.
Psychological Science, Research and Comparative Psychology,
Society on Alcoholism, and the and Experimental Psychology)
Association for Behavioral and and is past president of the
Cognitive Therapies. Dr. Maisto Division of Behavior Analysis.
was appointed editor for
Psychology of Addictive
Behaviors, a journal published by
the American Psychological
Association, for the term January
1, 2008 to December 31, 2013.
iv
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B R I E F C ON T E N T S
Preface xi
Chapter 1 Drug Use and Abuse 1
Chapter 2 Drug Use: Yesterday and Today 24
Chapter 3 Drugs and the Nervous System 47
Chapter 4 Pharmacology 70
Chapter 5 Psychopharmacology and New Drug Development 98
Chapter 6 Cocaine, Amphetamines, and Related Stimulants 123
Chapter 7 Nicotine 150
Chapter 8 Caffeine 179
Chapter 9 Alcohol 200
Chapter 10 Opiates 245
Chapter 11 Marijuana 266
Chapter 12 Hallucinogens 297
Chapter 13 Psychotherapeutic Medications 325
Chapter 14 Other Prescription and Over-the-Counter Drugs 365
Chapter 15 Treatment of Substance Use Disorders 387
Chapter 16 Prevention of Substance Abuse 430
Glossary 455
References 462
Index 501
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C ON T E N T S
Preface xi CHAPTER 3
Drugs and the
CHAPT ER 1
Nervous System 47
The Neuron 48
Drug Use and Abuse 1
Neural Transmission 49
Pharmacology and Drugs 3
Drug Classification 4 Drugs and Neural Transmission 52
The Drug Experience 5
Major Neurotransmitter Systems 55
Alcohol and Drug Use in the United States 6 Acetylcholine 55
National Household Survey 7 Monoamines 56
Summary of Survey Data 9 Endorphins 58
Multiple Drug Use 9 Amino Acid Neurotransmitters 58
International Comparisons of Drug Use 11 Other Transmitters 59
Negative Consequences of Alcohol and Drug
Use 13
The Nervous System 59
Defining Harmful Drug Use 13 The Brain 60
The Hindbrain 60
Use of the DSM 14
The Midbrain 62
Drug Tolerance, Withdrawal, and Drug-Taking
The Forebrain 62
Behavior 17
Imaging the Human Brain 65
Overview of the Text 19
Summary 67
Evaluating Websites 20
Summary 21
CHAPTER 4
CHAPT ER 2 Pharmacology 70
Drug Use: Yesterday Pharmacokinetics 72
and Today 24 Drug Dose 72
Routes of Administration 73
Historical Overview 25
Drug Absorption 78
Drug Use in the United States 27
Drug Distribution 80
Medical Science and Drug Use 30
Drug Elimination 81
Development of Drug Laws 33
Summary 85
The San Francisco Ordinance 33
Pure Food and Drug Act 34 Pharmacodynamics 86
Harrison Narcotics Tax Act 35 The Dose-Effect Curve 86
Alcohol Prohibition 35 Effective and Lethal Doses 90
Post-Prohibition Legislation 36 Drug Interactions 92
Current Drug Laws 38 Summary 95
Summary 44
vi
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Contents vii
CHAPTER 5 Effects of Chronic Use 141
Psychopharmacology Tolerance 142
Dependence 143
and New Drug Stimulant Drugs and ADHD 144
Development 98
Summary 147
Characteristics of Users 99
Biological Characteristics 100
Psychological Characteristics 100
Social and Environmental Factors 103
CHAPTER 7
Tolerance 104
Types of Tolerance 104 Nicotine 150
Explanations of Tolerance 105 History of Tobacco Use 152
Behavioral Pharmacology 109 The West Discovers Tobacco 152
Reinforcement and Punishment 109 Tobacco as Panacea 153
Operant Principles and Drug Dependence 110 From Panacea to Panned 154
Drug Discrimination 111 Prevalence of Tobacco Use 154
Conflict Paradigm 112 Smoking in the United States 154
Animal Models and Human Drug Use 113 Initiation of Smoking 156
Smokeless Tobacco Use 157
Human Behavioral Pharmacology 113
Ethical Questions 113 Pharmacology of Nicotine 158
Placebo Controls 114 Sites of Action 158
Pharmacokinetics 158
New Drug Development 116 Distribution 159
Clinical Trials and FDA Approval 116 Metabolism and Excretion 160
Distribution and Marketing 118
Generic Drugs 118 Tolerance and Dependence 161
Tolerance 161
Summary 120 Physical Dependence 161
Acute Effects of Nicotine 161
Nicotine’s Dependence Liability 163
CHAPTER 6 Effects of Chronic Tobacco Use 163
Cocaine, Amphetamines, Tar, Nicotine, and Carbon Monoxide 165
Diseases Linked to Cigarette Smoking 167
and Related Stimulants 123 Other Tobacco Products and Health 167
The Coca Leaf 124 Passive Smoking 168
Early Use of Cocaine 126 Treatment of Cigarette Smoking 170
The Necessity of Formal Treatment 170
The Amphetamines 128 Treatment Effectiveness 171
Cocaine Epidemic II 129 Conclusions about the Treatment of Cigarette
Smoking 174
The Return of Meth 134
Summary 176
Bath Salts 136
Pharmacokinetics of Stimulants 137
Mechanism of Stimulant Action 138
CHAPTER 8
Acute Effects at Low and Moderate Doses 139
Physiological Effects 139
Caffeine 179
Behavioral Effects 140 Sources of Caffeine 180
Acute Effects at High Doses 141 History of Caffeine Use 183
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viii Contens
Prevalence of Caffeine Consumption 183 Effects of Chronic Heavy Drinking 228
Alcohol and Brain Functioning 231
Pharmacology of Caffeine 186 Alcohol and the Liver 232
Sites of Action 186 Alcohol and Reproductive Functioning 233
Pharmacokinetics 186 Fetal Alcohol Syndrome 233
Tolerance and Dependence 187 Moderate Drinking and Health 235
Caffeine Withdrawal 188 The Development of Alcohol Use Disorder 237
Tolerance 188 Traditional Approaches to Etiology 237
Acute Effects of Caffeine 189 “Biopsychosocial” Approaches to Etiology 238
Behavioral and Psychological Effects 189 Summary 240
Interactions among Caffeine, Nicotine, and
Alcohol 191
Acute Toxic Effects of Caffeine 193
Chronic Effects of Caffeine Use 194
CHAPTER 10
Therapeutic Uses of Caffeine 196
Opiates 245
Conclusions 197
History of the Opiates 246
Summary 198
Early History 247
Opiate Use in the 19th Century 247
Opiate Use after the Harrison Act 249
The Making of an Epidemic 253
The Opiate Epidemic 254
CHAPT ER 9
Pharmacokinetics 256
Alcohol 200 Absorption 256
Distribution, Metabolism, and Excretion 256
Alcoholic Beverages 201
Fermentation and Distillation 201 Mechanisms of Opiate Action 256
Expressing the Alcohol Content of a Beverage 202 Discovery of Endorphins 257
What Do Endorphins Do? 257
History of Alcohol Use 204
Medical Use of Opiate Drugs 258
Consumption of Alcohol and Heavy Drinking
in the United States 206 Acute Psychological and Physiological Effects
Per Capita Consumption 206 of Opiates 260
Consumption of Alcohol and Heavy Drinking
Chronic Effects of Opiates 261
among College Students 209
Tolerance 261
Pharmacology of Alcohol 211 Withdrawal and Dependence 262
Sites of Action 211
Summary 263
Pharmacokinetics of Alcohol 211
Tolerance and Dependence 216
Tolerance 216
Physical Dependence 216
CHAPTER 11
Therapeutic Uses 218
Marijuana 266
Acute Effects of Alcohol 218
Physiological Effects 219 Historical Overview 268
Sensorimotor Effects 221 Cannabis in the New World 269
Alcohol and Driving Ability 221 Committee Reports on Marijuana 272
Psychological Effects 224
Epidemiology 273
Alcohol and Behavior 224
Methods of Use 277
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Contents ix
Active Ingredients 277 Effects of PCP and Ketamine 321
Potency of Cannabis 277 Psychotherapeutic Uses 321
Pharmacokinetics 278 Salvinorin A (Salvia) 322
Absorption 278
Summary 323
Distribution, Metabolism, and Excretion 279
Mechanisms of Action 279
Research Findings 279 CHAPTER 13
Tolerance and Dependence 280
Psychotherapeutic
Medical and Psychotherapeutic Uses 282
History of Therapeutic Use 282 Medications 325
Current Status of Medical Uses of Marijuana 284 Historical Overview 327
Physiological Effects 285 The Pre-Chlorpromazine Era 327
Acute Effects 285 The Age of Chlorpromazine 328
Longer-Term Effects 286 Epidemiology 329
Psychological Effects 288 Classes of Drugs and Their Actions 331
Behavioral Effects 288 Antipsychotics 331
Cognitive Effects 289 Antidepressants 337
Emotional Effects 291 Antianxiety Agents 344
Social and Environmental Effects 291 Nonbenzodiazepine Treatment 357
Summary 293 Mood-Stabilizing Drugs 357
Psychotherapeutic Drugs and Pregnancy 360
Summary 360
CHAPTER 12
CHAPTER 14
Hallucinogens 297
Other Prescription
Overview 298
and Over-the-Counter
Serotonergic Hallucinogens: LSD and Related
Compounds 299
Drugs 365
Early History 300 Overview 366
Recent History 302
Prescription Drugs 366
Mechanisms of Action of LSD-Like Drugs 306
Birth Control Drugs 366
Pharmacokinetics of LSD-Like Drugs 306
Anabolic Steroids 369
Psychotherapeutic Uses 307
Effects of Serotonergic Hallucinogens 308 Over-the-Counter Drugs 374
Adverse Effects of Serotonergic Hallucinogens 309 FDA Classification 374
Analgesics 375
Methylated Amphetamines 312
Cold and Allergy Medications 376
Overview 312
Over-the-Counter Stimulants and Sedatives 377
History and Epidemiology 313
Effects of Methylated Amphetamines 314 Herbal Products, Hormones,
Toxicity 316 and Dietary Supplements 377
Residual Effects of MDMA 316 Areca (Betel) 378
Psychotherapeutic Uses 318 DHEA 379
Ephedra/Ma Huang 379
Anticholinergic Hallucinogens 319
Ginkgo Biloba 379
Dissociative Anesthetic Hallucinogens 320 Kava 380
History 320 Kratom 380
Pharmacokinetics 320 Melatonin 381
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x Contens
S-Adenosyl-Methionine 381 Special Topics in Alcohol and Drug
St. John’s Wort 381 Treatment 418
Valerian 382 Treatment of Polysubstance Abusers 418
Gamma Hydroxybutyrate 382 Treatment of Dual-Diagnosis Patients 419
Inhalants 383 Relapse 419
Summary 384 Models of Causes and Treatment Methods 422
Economic Factors in Alcohol and Drug
Treatment 423
CHAPT ER 15 The Stepped Care Approach 425
Treatment of Substance Summary 426
Use Disorders 387
Motivation to Change 389
CHAPTER 16
Change without Formal Treatment 390
Prevention of Substance
Self-Help Groups 391
Alcoholics Anonymous 392 Abuse 430
Other Self-Help Groups 394 Defining Prevention 432
Models of Substance Use Disorders 396 Models of Prevention 433
Five Model Categories 396 Sociocultural Model 433
Biopsychosocial Model 397 Distribution of Consumption Model 435
Professional Treatment: Assessment and Proscriptive Model 436
Goals 398 Principles of Drug Abuse Prevention 437
Abstinence or Moderation? 399
Harm Reduction 400 Current Topics in Prevention 440
Education and Mass Media Efforts 441
Alcohol Treatment Settings and Services 401 Affect-Oriented Programs 443
Types of Settings and Services 401 Alternative Behaviors and Resistance-Skills
Pharmacological Treatment 403 Training 444
Effectiveness of Alcohol Treatment 405 Temperament-Based Interventions 445
Nonpharmacological Professional Treatment 405 Worksite Programs 446
Self-Help Treatment 407 Programs for College Students 448
Effectiveness of Pharmacological Treatments 409
Closing Comments on Prevention 451
Other Drug Treatment Settings and
Services 411 Summary 451
Treatment of Nonopiate Drug Use Disorder 411
Pharmacotherapy of Other Drug Use Disorders 412 Gloss ary 455
Effectiveness of Drug Treatment 414
Nonpharmacological Professional Treatment 414 Referen ces 462
Self-Help Treatment 415
Pharmacological Treatments 415 Index 501
Promising Treatment Techniques 417
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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 eighth edition, which retains many
features of previous editions but also reflects changes that have occurred in this very
dynamic area of study since the seventh edition was published in 2015.
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
explanations at the end of each chapter provide an important review of the main
concepts. 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
highlight 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 seventh edition was published in 2015, synthetic designer
drugs like “Spice” and “bath salts” had recently emerged as international phenom-
ena. These designer drugs are sold on the Internet, often legally. The eighth edi-
tion 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 Preven-
tion Act of 2012, Chapter 2) and reviews of the major drugs involved: synthetic
cathinones or bath salts (Chapter 6), synthetic opiate drugs (Chapter 10), synthetic
cannabinoids or Spice (Chapter 11), and phenethylamine hallucinogens (2C-B,
Chapter 12).
xi
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xii Preface
Numerous other changes have occurred in the field since publication of the sev-
enth edition. Each chapter of the eighth edition has been updated to represent find-
ings from the latest research, as well as to reflect social and legal changes related to
drugs. 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 world-
wide. Chapter 2, “Drug Use: Yesterday and Today,” includes new information on the
voter and legislative approvals in multiple states to regulate, tax, and control mari-
juana use and distribution, updates on the continuing movement to legalize the use
of marijuana for medical reasons, and new coverage on the synthetic opioid fentanyl
being used alone or mixed with heroin.
Chapter 3, “Drugs and the Nervous System,” adds detail on how drugs affect
neurotransmission processes.
Chapter 6, “Cocaine, Amphetamines, and Related Stimulants,” adds information
on the changing trends in cocaine and methamphetamine use, as well as new infor-
mation about synthetic cathinones (bath salts).
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. The latter
includes how the concept of precision medicine is influencing the pharmacological
treatment of tobacco cigarette smoking. Chapter 7 also features updated material on
the harm-reduction approach to cigarette smoking, including expanded 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 vari-
ety of apparent health benefits of coffee. Also included are new insights on the
metabolism of caffeine, including the genetics of caffeine consumption. The chapter
also features coverage of caffeine withdrawal as a clinical phenomenon. 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,” provides extensive new coverage of the dramatic increase
in use of heroin, prescription opiates, and synthetic opiates. Two new sections are
included on the events that led to the opiate epidemic and the current status and
impact of the epidemic. The increase in opiate overdose deaths is chronicled and we
add a new box on treating overdose with naloxone.
The chapter on marijuana (Chapter 11) includes the latest epidemiological data
on marijuana use around the world, including use among youth. Chapter 11 also
contains the latest information on the therapeutic uses of marijuana, on the relation-
ship between cannabis use and various mental health outcomes, and on newer meth-
ods of consumption (such as vaping and dabbing).
Chapter 12 covers the exciting new research on psychological effects of hallucino-
gens, especially psilocybin and MDMA. New sections expand coverage of the thera-
peutic uses of hallucinogens like psilocybin for anxiety and depression, MDMA for
post-traumatic stress disorder, and ketamine for depression. A new box discusses the
potential and challenges for medical use of hallucinogens.
Chapter 13, “Psychotherapeutic Medications,” includes the most recent data on
the nature and extent of mental illness in the United States. It also includes the latest
information on newly prescribed psychotherapeutic medications, with discussion of
their benefits and side effects. Chapter 13 also provides coverage of the use of
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Preface xiii
psychotherapeutic medications during pregnancy, which often has been a difficult
and challenging issue for pregnant women and their physicians alike.
Chapter 14, “Other Prescription and Over-the-Counter Drugs,” adds coverage of
the controversial plant compound “kratom” which has become popular in recent years.
Chapter 15, “Treatment of Substance Use Disorders,” includes a new Contem-
porary Issue Box on the use of telehealth (the use of technology, such as electronic
medical records, smart phones, and web-based applications to support the delivery
of health care, health-related education, and other health-related services and func-
tions) in efforts to help patients sustain changes that they make in treatment, added
discussion of the effectiveness of mutual help support groups such as Alcoholics
Anonymous, and updated information on the integration of the Affordable Care
Act in our discussion of economics and the stepped-care approach to substance use
disorders treatment.
Chapter 16, “Prevention of Substance Abuse,” covers the latest trends in preven-
tion interventions, including temperament-based programs that focus on traits, such
as sensation-seeking and anxiety sensitivity, uniquely associated with risk for subse-
quent development of a drug-related problem. Updates on the broad array of nega-
tive consequences associated with problematic use of alcohol among college students,
including deaths, assault, sexual abuse, and academic problems, are provided.
Accompanying the eighth edition are both new and expanded supplements that
will help instructors with class preparation and help students by providing opportuni-
ties for review, including an Instructor’s Manual, Test Bank, Instructor PowerPoints,
an online companion website, and MindTap. The Instructor’s Manual provides chap-
ter outlines, learning objectives, key terms, glossary terms and definitions, and useful
web links. The Instructor’s Manual follows the text chapter by chapter with orga-
nized material to aid in planning an effective, engaging course. To aid instructors in
integrating technology into their classroom, the manual also includes a MindTap
Integration Chart and Educator’s Guide, designed to highlight important activities
and content found in MindTap.
The Test Bank is available in Cognero electronic format, an online system which
allows instructors to author, edit, and manage test bank content from multiple Cen-
gage solutions. Instructors may also easily create multiple test versions in an instant
and deliver tests from a chosen Leaning Management System (LMS), the classroom,
or anywhere else internet access is available. The test bank features multiple choice,
true/false, and essay questions. Questions are tagged to Bloom’s Taxonomy and to
the associated text content.
Instructor PowerPoint presentations accompany each chapter. These slides address
all major topics covered within the text in an easy-to-use and condensed format.
Slides may be used to guide classroom presentations or conversations, as a classroom
handout for student preparation, or as an additional student resource for chapter
review. Instructors may customize the slides to best suit their course.
A student companion website offers text-specific review and enrichment materials,
including tutorial quizzes, flashcards, and an online glossary. An instructor compan-
ion website features the instructor’s manual, PowerPoint lectures, and test
bank materials.
The eighth edition also includes MindTap. MindTap ®, a digital teaching and
learning solution, helps students be more successful and confident in the course—
and in their work with clients. MindTap guides students through the course by com-
bining the complete textbook with interactive multimedia, activities, assessments,
and learning tools. Readings and activities engage students in learning core concepts,
practicing needed skills, reflecting on their attitudes and opinions, and applying what
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