DOCUMENT RESUME ED 348 604 CG 024 422 TITLE Drug Abuse and Drug Abuse Research. The Third Triennial Report to Congress from the Secretary, Department of Health and Human Services. INSTITUTION National Inst. on Drug Abuse (DHHS/PHS), Rockville, Md. REPORT NO DHHS-Pub-NO-(ADM)91-1704 PUB DATE 91 NOTE 284p. PUB TYPE Reports General (140) EDRS PRICE MFO1 /PC12 Plus Postage. DESCRIPTORS Cocaine; *Drug Abuse; Drug Rehabilitation; Drug Use; Incidence; Mental Disorders; Public Policy; Research Problems; Smoking; Trend Analysis; Use Studies ABSTRACT This report summarizes changes that have occurred in understanding of the health implications of the use and abuse of illegal and legal drugs as a result of research since 1986. It is noted that wherever possible, research findings have been summarized in non-technical language. Some technical material is included because of its basic importance and its relevance to the needs of specialists working on related problems and of those advising lawmakers and other civil authorities on public policy. These chapters are included:(1) "Nature and Extent of Drug Abuse in the United States" which discusses prevalence and consequences of drug use; (2) 'Prevention Research" which discusses individual and environmental risk factors;(3) "Treatment Research" which summarizes treatment methods;(4) "Dual Diagnosis: Drug Abuse and Psychiatric Illness" which presents diagnostic issues and treatment strategies for dual disordered patients; (5) "AIDS (Acquired Immunodeficiency Syndrome) and Intravenous Drug Abuse";(6) "Cocaine and Other Stimulants"; (7) "Marijuana and the Cannabinoids" which discusses health consequences; (8) "Phencyclidine (PCP) and Related Substances"; (9) "Heroin, Other Opiates, and the Immune Function" which focuses on recent research accomplishments; (10) "Sedatives and Anti-Anxiety Drugs"; (11) "Nicotine Dependence"; and (12) "Basic Research on Opioid Peptides and Receptors" which summarizes opioid advances. Bibliographies are included with each chapter. Statistics, tables, and graphs illustrate the report. Author and drug indexes are included. (ABL) *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** UG 'OUSE AN : e L THE THIRD TRIENNIAL REPORTTd,CONGRESS Egi_n_ FROM THE SECRETARY, DEPARTMENT OF HEALTI, AND HUMAN SERVICES U S DEPARTMENT OF EDUCATION Othce of Educational Research and improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) Th.5 document has teen reproduced as receyed from the person or orpanrzatron ohgmatmg C M,nor changes nave been made 10 .rnb,Ove ,e0,0C1UCI.On quaidy Po.nts of v,ew or opinions stated in th.sdocu ment co not necessarily represent of froal OE RI poso.on or pol.cy w BEST COPY AVAILABLE2 11 DRUG ABUSE AND DRUG ABUSE RESEARCH The Third Triennial Report to Congress from the Secretary, Department of Health and Human Services U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Doug Abuse 5600 Fishers Lane Rockville, Maryland 20857 Certain tables and figures, as noted in the text, are copyrighted and are reproduced herein with permission of the copyright holders and of the authors. Further reproduction of these copyrighted materials is prohibited without specific permission of the copyright holders. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the National Institute on Drug Abuse or the authors. Citation of the source is appreciated. The U.S. Government does not endorse or favor any specific commercial product or company. Trade or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein. DHHS Publication No. (ADM)91-1704. Printed 1991. Acknowledgments AIDS and Intravenous Drug Abuse Preparation of the Third Triennial Report on Drug Dr. Wayne Wiebel and Mr. Thomas Lampinen, Abuse and Drug Abuse Research to the Congress from University of Illinois at Chicago the Secretary, Department of Health and Human Services, has been accomplished through the generous Cocaine and Other Stimulants cooperation of many members of the scientific Dr. Scott Lukas, McLean Hospital, Belmont, community.By making available their current Massachusetts research findings and recent work of other experts in the field of drug abuse, they have made it possible to Marijuana and the Cannabinoids include more up-to-date information than could Drs. Louis S. Harris and William Martin, Virginia otherwise have been presented. Commonwealth University Their contributions to the following chapters of the Phencyclidine and Related Substances report are gratefully acknowledged: Drs. James Woods and Gail Winger, University of Michigan Nature and Extent of Drug Abuse in the United States Heroin, Other Opiates, and the Immune Function Mr. Joseph Gfroerer, Division of Epidemiology and Dr. Mary Jeanne 'Creek, Rockefeller University Prevention Research, National Institute on Drug Abuse Sedatives and Anti-Anxiety Drugs Dr. Michiko Okamoto, Cornell University Medical Prevention Research College Dr. Ray Lorion, University of Maryland Nicotine Dependence Treatment Research Dr. Jack Henningfield, Addiction Research Center, Dr. George E. Bigelow, Johns Hopkins University National Institute on Drug Abuse School of Medicine Basic Research on Opioid Peptides and Receptors Dual Diagnosis: Drug Abuse and Psychiatric Drs. Huda Akil and Stanley Watson, University of Illness Michigan Dr. Thomas McLellan, University of Pennsylvania iii 5 Dr. Chris-Ellyn Johanson, Uniformed Services Additional assistance in reviewing the material University of the Health Sciences contained in this report was provided by members of the staff of the National Institute on Drug Abuse and Dr. Howard Kalant, University of Toronto by: Dr. HoArd Kaplan, Texas A & M University Dr. James Anthony, Johns Hopkins School of Dr. Marlyne Kilbey, Wayne State University Hygiene and Public Health Dr. Herbert D. Kleber, Yale University Dr. Robert L. Balster, Medical College of Dr.Edward Lichtenstein, Oregon Research Virginia Institute Dr. Floyd Bloom, Research Institute of Scripps Dr. Charles O'Brien, University of Pennsylvania Clinic Dr. Don Des Jarlais, Narcotic and Drug Dr. Patrick O'Malley, University of Michigan Research, Inc. Dr.Mario Perez-Reyes, University of North Carolina at Chapel Hill Dr. Edward F. Domino, University of Michigan School of Medicine Dr. Bruce J. Rounsaville, Yale University School of Medicine Dr. Lynda Dykstra, University of North Carolina Dr.Solomon H. Snyder, Johns Hopkins Dr.Marian W. Fischman, Johns Hopkins University School of Medicine University Ms. Nancy Tobler, Univen# of Albany Dr.Brian R. Flay, University of Illinois at Chicago Dr. William L. Woolverton, University of Chicago Dr. Roland R. Griffiths, Johns Hopkins School of Medicine The contributions of those named and of the larger scientific community are gratefully acknowledged. Dr.John E. Helzer, Washington University School of Medicine Mrs. Mary Louise Embrey and Dr. Christine R. Dr.Leo Hollister, Harris County Psychiatric Hartel at the National Institute on Drug Abuse had Center overall responsibility for preparation of the report. Mrs. Sally Breul assisted in administering and coor- Dr. John Hughes, University of Vermont dinating the preparation of the report, and Dr. Robert Petersen served as technical editor. iv Contents Page Acknowledgments iii Preface vi Executive Summary 1 Nature and Extent of Drug Abuse in the United States 13 Prevention Research 31 Treat-nent Research 47 Dual Diagnosis: Drug Abuse and Psychiatric Illness 61 AIDS and Intravenous Drug Abuse 85 Cocaine and Other Stimulants 111 Marijuana and the Cannabinoids 131 Phencyclidine (PCP) and Related Substances 145 Heroin, Other Opiates, and the Immune Function 161 Sedatives and Anti-Anxiety Drugs 189 Nicotine Dependence 213 Basic Research on Opioid Peptides and Receptors 243 Author Index 261 Drug Index 279 Preface Today, no domestic issue captures the attention of the American public to the extent that drug abuse does. From the morning paper to the evening news, we are updated daily about the health and social problems that are caused by the use of dependence producing drugs. These drugs may be illegal ones like cocaine and marijuana or legal ones like nicotine and alcohol.There is no question of the pervasiveness of their use. One in three Americans have used an illicit drug at some time during their lives. In the last 3 years, the U.S. Congress has authorized the spending of many millions of dollars to combat drug abuse problems in all their many aspects.The President, through the National Drug Control Strategy, has set an agenda for our Nation to become drug free. Drug Abuse and Drug Abuse Research, The Third Triennial Report to Congress summarizes the changes that have occurred in our understanding of the health implications of the use and abuse of illegal and legal drugs as a result of research since 1986. Research into these biological and social factors continues to prove how much we still have to learn. Though much remains to be done, the Triennial Report traces a record of research advances we can be proud of.It shows us that dependence producing drugs, even those with social or legal acceptability like nicotine, exact too