The Pharmacology of Alcohol and Drugs of Abuse and Addiction

The Pharmacology of Alcohol and Drugs of Abuse and Addiction

Norman S. Miller The Pharmacology of Alcohol and Drugs of Abuse and Addiction Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona

Norman S. Miller, M.D. Cornell University Medical College New York Hospital-Cornell Medical Center 21 Bloomingdale Road White Plains, New York 10605 USA With 3 illustrations. Library of Congress Cataloging-in-Publication Data Miller, Norman S. The pharmacology of alcohol and drugs of abuse and addiction / Norman S. Miller. p. cm. Includes bibliographical references. Includes index. ISBN-13: 978-1-4612-7774-3 e-isbn-13: 978-1-4612-3044-1 DOl: 10.1007/978-1-4612-3044-1 1. Alcoholism-Physiological aspects. 2. Substance abuse Physiological aspects. 3. Alcohol-Physiological effect. 4. Psychotropic drugs - Physiological effect. 5. Neuropsychopharmacology. I. Title. [DNLM: 1. Alcohol, Ethyl-pharmacology. 2. Narcoticspharmacology. 3. Street Drugs-pharmacology. 4. Substance Abuse. 5. Substance Dependence. QV 84 M649pj RC565.M444 1990 615'.78-dc20 DNLMIDLC for Library of Congress Printed on acid-free paper. 1991 Springer-Verlag New York Inc. Softcover reprint of the hardcover 1 st edition 1991 90-10046 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the lfade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. 1}rpeset by Bytheway 'JYpesetting Services, Norwich, NY. 9 8 765 432 1

To my wife Nicole, and my daughters Mia and Natasha. Persistent partisans who generously devoted their time for this book.

Preface This volume is intended for clinicians, researchers, residents, and students. The range is wide and the depth considerable for all the topics covered in the treatment of this timely and relevant subject. This book may serve equally well as a general introduction and a scholarly reference. Ultimately, it is designed to serve those patients suffering from abuse of and addiction to drugs and alcohol. The content and organization of the book flow from general concepts of abuse and addiction to specific details of the pharmacology of alcohol and drugs. Special chapters on topics not found in most other books, such as pharmacology of drug-drug interactions, abstinence, and prevention, are included. This book is written especially for the clinician interested in the pharmacology of alcohol and drugs of abuse and addiction. The pharmacology is integrated into a conceptual approach to diagnosis and treatment of alcohol and drug abuse and addiction. The form and style are didactic, critical as well as straightforward in presentation. Literature references from recent clinical research and basic research provide the foundation for the chapters throughout the book. Because the book is written by a clinician-researcher, the information is readily adaptable to clinical problems and research ideas. I would like to express my deep appreciation to Susan Newsom and Darlene Tucci for their invaluable technical assistance. Norman S. Miller vii

Contents Preface... vii CHAPTER 1 Introduction to the Pharmacological Effects of Alcohol and Drugs and Addiction on the Brain and Behavior.............................. 1 CHAPTER 2 The Behavioral Concepts of Abuse and Addiction in Diagnosis... 9 CHAPTER 3 The Neurochemistry of Tolerance, Dependence, and Addiction... 25 CHAPTER 4 Suicide in Alcoholism and Drug Addiction... 45 CHAPTER 5 The Genetics of Alcoholism... 55 CHAPTER 6 The Medical Consequences of Alcohol and Drugs of Abuse and Addiction... 63 CHAPTER 7 The Psychiatric Consequences of Alcohol and Drugs of Abuse and Addiction... 77 CHAPTER 8 The Pharmacology of Alcohol and Drugs and Sexual Responsivity... 89 CHAPTER 9 The Pharmacology of Alcohol... 101 CHAPTER 10 The Pharmacology of Amphetamines... 113 ix

x Contents CHAPTER 11 The Pharmacology of Anabolic-Androgen Steroids... 125 CHAPTER 12 The Pharmacology of Benzodiazepines... 133 CHAPTER 13 The Pharmacology of Cocaine... 153 CHAPTER 14 The Pharmacology of Hallucinogens and Designer Drugs... 173 CHAPTER 15 The Pharmacology of Inhalants and Volatile Solvents... 185 CHAPTER 16 The Pharmacology of Marijuana (Cannabis)... 199 CHAPTER 17 The Pharmacology of Multiple Drug and Alcohol Addiction... 215 CHAPTER 18 The Pharmacology of Narcotics: Natural, Semisynthetic, and Synthetic... 227 CHAPTER 19 The Pharmacology of Nicotine... 241 CHAPTER 20 The Pharmacology of Nonprescription Medications... 249 CHAPTER 21 The Pharmacology of Phencyclidine... 259 CHAPTER 22 The Pharmacology of Sedatives/Hypnotics... 265 CHAPTER 23 The Pharmacology of Interactions Between Medical and Psychiatric Drugs... 279 CHAPTER 24 The Pharmacology of Drug Testing: Indications and Methodology... 291 CHAPTER 25 The Pharmacological Treatment of the Acute Intoxication and Detoxification of Alcohol and Drugs of Abuse and Addiction... 307 CHAPTER 26 The Pharmacology of Abstinence... 327

Contents xi CHAPTER 27 The Nonpharmacological Treatment of Abuse and Addiction to Alcohol and Drugs... 335 CHAPTER 28 The Prevention of Abuse and Addiction to Alcohol and Drugs... 345 Index... 351