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Cocaine Use in America: Epidemiologic and Clinical Perspectives DOCUMENT RESUME ED 268 463 CG 019 022 AUTHOR Kozel, Nicholas J., Ed.; Adams, Edgar H., Ed. TITLE Cocaine Use in America: Epidemiologic and Clinical Perspectives. National Institute on Drug Abuse (NIDA) Research Monograph Series 61. INSTITUTION National Inst. on Drug Abuse (DHHS/PHS), Rockville, Md. REPORT NO DHHS-ADM-85-1414 PUB DATE 85 NOTE 243p. AVAILABLE FROMSuperintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. PUB TYPE Reports - Research/Technical (143) -- Collected Works General (020) EDRS PRICE MF01/PC10 Plus Postage. DESCRIPTORS *Adolescents; *Behavior Patterns; *Drug Abuse; *Illegal Drug Use; Individual Characteristics; *Trend Analysis; *Young Adults IDENTIFIERS *Cocaine ABSTRACT This monograph is based on papers presented at a technical review of patterns of cocaine use in the United States which was held in 1984. The foreword by Jerome H. Jaffe acknowledges that, over the past 10 years, cocaine has become a major public health threat in this country. Papers contained in this monograph include: (1) "Cocaine Use in America: Introduction and Overview" by Edgar H. Adams and Nicholas J. Kozel; (2) "Cocaine Use in the United States: In a Blizzard or Just Being Snowed?" by Richard R. Clayton; (3) "A Decade of Trends in Cocaine Use in the Household Population" by Herbert I. Abelson and Judith Droitcour Miller; (4) "Cocaine Use Among American Adolescents and Young Adults" by Patrick M. O'Malley, Lloyd D. Johnston, and Jerald G. Bachman; (5) "Cocaine Use in Young Adulthood: Patterns of Use and Psychosocial Correlates" by Denise B. Kandel, Debra Murphy, and Daniel Karus; (6) "Patterns and Consequences of Cocaine Use" by Dale D. Chitwood; (7) "Cocaine Abuse: Neurochemistry, Phenomenology, and Treatment" by Mark S. Gold, Arnold N. Washton, and Charles A. Dackis; (8) "Reinforcement and Rapid Delivery Systems: Understanding Adverse Consequences of Cocaine" by Sidney Cohen; (9) "Characteristics of Humans Volunteering fora Cocaine Research Project" by C.R. Schuster and M.W. Fischman; (10) "Characteristics of Cocaine Abusers Presenting for Treatment" by Sidney H. Schnoll, Judy Kerrigan, Sarah B. Kitchen, Amid Daghestani, and Thomas Hansen; (11) "Cocaine Use in a Treatment Population: Patterns and Diagnostic Distinctions" by Frank H. Gawin and Herbert D. Kleber; (12) "Cocaine: Treatment Perspectives" by Donald R. Wesson and David E. Smith; (13) "New Patterns of Cocaine Use: Changing Doses and Routes" by Ronald K. Siegel; and (14) "Cocaine Use in America: Summary of Discussions and Recommendations" by Nicholas J. Kozel and Edgar H. Adams. The document concludes with a list of National Institute on Drug Abuse research monographs. (NB) Pr National .cInstitute on co Drug N MONOGRAPH SERIES Cocaine Use in America: Epidemiologic and Clinical Perspectives O 1 O U DEPARTMENT OF EDUCATION CD NATIONAL INSTITUTE OF EDUCATION EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) /This document has bean reproduced as received from the Peron or organuatior onspnating it Minor changes have been made to Improve reproduction quality Points of stew or opinions stated in this docu ment do not necessarily represent official NIE positon or policy Alcohol, Drug Abusa. and *roof Health Administration U S DEPARTMENT Of HEALTH AND HUMAN SERVICES PAR Health Sams 2 Cocaine Use in America: Epidemiologic and Clinical Perspectives Editors: Nicholas J. Kozel, M.S. Edgar H. Adams, M.S. Division of Epidemiology and Statistical Analysis National Institute on Drug Abuse NIPA Research Monograph 61 1985 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse 5800 Fishers Lane Rockville, Maryland 20857 For sale by the Superintendent of Documents, U S Government Printing Office Washington. DC 20402 NIDA Research Monographs are prepared by the research divisions of the National Institute on Drug Abuse and published by its Office of Science The primary objective of the senes is to provide cntical reviews of research problem areas and techniques, the content of state-of-the-art conferences, and Integra- five research reviews Its dual publication emphasis is rapid and targeted d...sem- ination to the scientific and professional community Editorial Advisors Martin W. Adler, Ph.D. Temple University School of Medicine Philadelphia, Pennsyryonso Sydney Archer, Ph.D. Rensselaer Pct./technic institute Troy, New York Richard E Belleville, Ph.D. NB Associates. Health Sciences Roc Wile. Maryland Gilbert J. BoMn, Ph.D. Cornell Univerely Medical College New York New York Joseph V. Brody, Ph.D. The Johns Hopkins University School of Medicine Baltimore, Maryland Theodore J. Cicero, Ph.D. Washington I kiversity School or Medicine St Loup k nourl Sidney Cohen, M.D. Los Angeles. Callfcenia Reese T. Jones, M.D. Langley Porter NeLsopsychialtic Institute San Frarcisco, Coliforryo Denise Kandel, Ph.D. College or Physicians and Surgeons or Columba University New Yolk New York Herbert Kleber, M.D. Yale University School or Medicine New KaAsn, Connecticut NIDA Research Monograph Series WaffleJail., MD. ACTING DIRECTOR NIDA Jock Duro', MD. ASS, '11E DIRECTOR FOR SCIENCE NIDA EDIT0i. eV-CHEF Eleanor W. Waldrop MANAGING EDITOR Paeldown OuNdIng, 5603 Reims Law Rockville, Maryland 20057 4 Cocaine Use in America: Epidemiologic and Clinical Perspectives 5 ACKNOWLEDGMENT This monoeraph is based upon papers presented at a technical review of patterns of cocaine use in the United States which took place on July 11-13, 1984, at Bethesda, Maryland. The conference was sponsored by the Division of Epidemiology and Statistical Analysis, National Institute on Drug Abuse. COPYRIGHT STATUS All material in this volume except quoted passages from copy- righted sources is in the public domain and may be used or repro- duced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in th': volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product or commodity. Trade or proprietary names appearing in this publication are used only because they are con- sidered essential in the context of the studies reported herein. DNS publication number (ADM)85-1414 Printed 1985 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of 71-ciaTfifistics Index, BioSciences Information Service,Chem171176ifFiEfF, ir7n--rentiaTheffis,PEZITrisygcalETt-actsr-dirisychwharmacology Abstracts. iv 6 Foreword Over the past 10 years, cocaine, which has been characterized as powerfully addictive, has evolved from a relatively minor problem into a major public health threat. In the early 1970s, evidence on the reinforcing potential of cocaine suggested that if the use of the drug became widespread major social and public health problems could ensue. Fortunately, NIDA had epidemiologic surveys and surveillance systems in place which enabled it to monitor the prevalence of drug use, cocaine- related emergency room cases, and treatment admissions. These efforts have documented dramatic increases in the use of cocaine in the general adult and high school populations of the United States. As the use of cocaine increased, parallel increases in emergency room visits, overdose deaths, and clinical problems reflected by increased t.eatment admissions were noted. Although the prevalence of cocaine use in the general population appears to have leveled off since 1979, the adverse consequences have con- tinued to increase dramatically. Several explanations, including . increased combination drug use, a shift to more dangerous routes of administration, and the lag time from first use to entry into treatment have been offered to explain this phenomenon. There is evidence to suggest that each of these explanations may in fact contr4bute to the increased negative consequences associated with cocaine. Yet, as much as we know about the epidemiology of cocaine use, many questions remain. It ;s unknown, for example, whether the increasing number of freebase users seen by clinicians reflects an increase in the numbers of people smoking freebase or a reflection of the increased risk of this route of administra- tion. While our surveys have given u good estimates of the number of people who have used cocaine, we still need an estimate of the proportion of the using pcpulation who have experienced problems due to their drug use. In contrast, clinicians often see the problem users but may not collect sufficient drug histories so that risk may be assessed and have no contact with users who are not experiencing problems. The dialogue between epidemiologists and clinicians at the technical review on which this monograph is based increased the awareness of these issues and the benefits to be derived from increased interaction between epidemiologists and clinicians. One resu1c of the technical review was the inclusion of a problem measurement section in the 1985 National Household Survey on Drug Use. Another is the publication of this monograph which represents an important contribution to our understanding of cocaine use and abuse. Jerome H. Jaffe, M.D. Acting Director National In,titute on Drug Abuse Contents Foreword Jerome Jaffe Cocaine Use in America: Introduction and Overview Edgar H. Adams and Nicholas J. Kozel 1 Cocaine Use
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