Substance Abuse in Adolescents and Young Adults (eBook)

Author Index 17
Foreword 23
Abbreviations 25
1 Introduction: Substance abuse in adolescents and young adults 29
Section I: Etiology and diagnosis 39
2 Neurobiology of substance use disorders 41
2.1 Introduction 41
2.2 General concepts 41
2.2.1 Dopamine 43
2.2.2 Serotonin and norepinephrine 45
2.2.3 GABA 45
2.3 Neuropharmacology of specific drugs 46
2.3.1 Stimulants 46
2.3.2 Alcohol 47
2.3.3 Opioids 48
2.3.4 Nicotine/tobacco 48
2.3.5 Cannabinoids 50
2.4 Summary 51
3 Genetic influences on substance abuse disorders 55
3.1 Introduction 55
3.2 Limitations 56
3.3 Gene classes 57
3.4 Specific addictions 58
3.4.1 Alcohol 58
3.4.2 Cannabis 59
3.4.3 Tobacco 60
3.4.4 Others 60
3.5 Epigenetic effects 61
3.6 Complex diseases 62
3.7 Conclusion 62
4 Essential diagnostic considerations 67
4.1 Introduction 67
4.2 Review of the literature 69
4.3 Epidemiology 69
4.4 Empirical studies of assessment instruments 70
4.5 Comorbidity 71
4.6 Assessment 71
4.7 Screening 73
4.8 Diagnosis 83
4.9 Biochemical testing 85
4.10 Discussion 86
Section II: Treatment 89
5 Psychosocial treatments for substance use disorders 91
5.1 Introduction 91
5.2 Motivational treatments 92
5.2.1 Precontemplation stage 92
5.2.2 Contemplation stage 93
5.2.3 Preparation stage 94
5.2.4 Action stage 95
5.2.5 Maintenance stage 96
5.2.6 Contemplation of relapse 97
5.3 CM and community reinforcement approaches (CRAs) 97
5.3.1 CM 97
5.3.2 CRA 98
5.4 Cognitive behavioral approaches 99
5.4.1 Functional analysis 100
5.4.2 Drug refusal skills 101
5.4.3 RP 101
5.5 Family interventions 102
5.5.1 Multidimensional family therapy (MDFT) 103
5.6 Conclusion 104
6 General pharmacotherapy principles 107
6.1 Introduction 107
6.2 Evaluation for pharmacotherapy 107
6.3 When is pharmacotherapy appropriate? 109
6.4 Conclusion 110
7 Use of pharmacological agents for smoking cessation 113
7.1 Introduction 113
7.2 Epidemiology 113
7.3 Chemistry and pharmacology 115
7.4 Effects on health 117
7.5 Behavioral approaches to smoking cessation 121
7.6 Pharmacological agents 121
7.6.1 Varenicline 123
7.6.2 Bupropion SR 124
7.6.3 Nicotine replacement therapies 125
7.6.4 Second-line medications 130
7.6.5 Vaccine 131
7.6.6 E-cigarettes 131
7.7 Conclusion 132
8 Marijuana: Current concepts and conundrums 137
8.1 Introduction 137
8.1.1 Cannabis sativa plant 137
8.1.2 Prevalence 138
8.1.3 Cannabis lab testing 145
8.2 Medical adverse effects 146
8.2.1 Cannabis hyperemesis 147
8.2.2 Dental effects of cannabis 147
8.2.3 Pulmonary effects 148
8.2.4 Cannabis and cancer 149
8.2.5 Cardiovascular effects 149
8.2.6 Motor vehicle accidents 150
8.2.7 Sports doping 150
8.2.8 Adverse effects: Psychiatric 150
8.2.9 Management 155
8.2.10 Pharmacological therapies 157
8.2.11 Cannabis intoxication 158
8.2.12 Cannabis withdrawal 158
8.3 Cannabis-associated psychosis 158
8.3.1 Cannabis dependence 158
8.4 Summary 160
9 Primary care management of alcohol use disorders of adolescents and young adults 173
9.1 Introduction 173
9.2 Epidemiology: Drinking patterns and beverage preferences 174
9.2.1 Drinking patterns 174
9.2.2 Drinking preferences 174
9.3 Confidentiality in primary care 175
9.4 Screening in primary care 176
9.4.1 Screening 176
9.4.2 Screening tools 177
9.5 Assessment of risk 178
9.5.1 Screening the college student 180
9.6 BIs for the primary care office 180
9.7 MI 181
9.8 A clinical vignette 182
9.9 Specific BIs for college students 184
9.10 Sedative/hypnotics 185
9.10.1 Epidemiology 185
9.10.2 Associated problems 185
9.11 Conclusions 186
10 Opioids and prescription drugs 191
10.1 Introduction 191
10.2 Prescription drugs 191
10.3 Analgesics 192
10.4 Tranquilizers 194
10.5 Stimulants 195
10.6 Others 196
10.7 OTC drugs 196
10.8 DXM 197
10.9 Antihistamines 197
10.10 Illicit opioids 197
10.11 Conclusion 198
11 Illicit stimulant abuse in adolescents and young adults 201
11.1 Introduction 201
11.2 History of cocaine and methamphetamine 202
11.3 Epidemiology 203
11.4 Risk factors and comorbidity 205
11.5 Pharmacology and pathophysiology 206
11.6 Clinical manifestations of intoxication, overdose, and withdrawal 207
11.7 Identification of warning signs 212
11.8 Problem use (abuse and dependence) 214
11.9 Treatment of illicit stimulant abuse and dependence 215
11.10 Biological treatments 215
11.11 Behavioral treatments 216
11.12 Clinical management of co-occurring ADHD and stimulant use disorders 218
11.13 Summary 219
12 Date rape drugs and hallucinogens 223
12.1 Introduction 223
12.2 Hallucinogens 224
12.2.1 LSD 224
12.2.2 Mescaline (2,3,4-trimethoxy-phenethylamine) 225
12.2.3 Psilocybin (and closely related psilocyn) 226
12.2.4 Salvia divinorum 227
12.2.5 PCP 228
12.2.6 Ketamine 229
12.2.7 MDMA 230
12.2.8 Methamphetamine 231
12.3 Date rape drugs 233
12.3.1 GHB 233
12.3.2 Flunitrazepam (Rohypnol) 234
12.4 Epidemiology 235
12.5 Diagnosis 236
12.6 Management principles 237
12.7 Conclusions 238
13 The role of the pediatrician and primary care clinician 243
13.1 Introduction 243
13.2 Screening and assessment 244
13.3 Confidentiality and consent 246
13.4 Safety 248
13.5 Screening tools and algorithm in adolescents 251
13.6 Screening tools in young adults 254
13.7 Summary 255
13.8 Brief intervention 256
13.9 Referral to treatment and the primary care clinician’s role intreatment 258
13.10 Conclusions 259
Section III: Special populations 265
14 Substance use disorders in adolescents and young adults: Comorbidity and treatment 267
14.1 Introduction 267
14.2 Common comorbid psychiatric conditions 267
14.2.1 Clinical samples 268
14.3 General principles of assessment and diagnosis 268
14.4 General principles of treatment 269
14.4.1 ADHD 270
14.4.2 Depressive disorders 274
14.4.3 BPD 278
14.4.4 Psychotic disorders 278
14.4.5 Anxiety disorders 279
14.4.6 Treatment recommendations and prognosis 280
15 Adolescent girls and substance abuse: Recent trends, risk factors, and consequences 285
15.1 Introduction 285
15.2 Gender differences in substance abuse 285
15.3 Risk factors for substance abuse in female adolescents 286
15.3.1 Puberty status and timing 287
15.4 Hormonal changes and emotional reactivity 288
15.5 Childhood sexual abuse 289
15.6 Consequences of substance abuse in female adolescents 290
15.7 Substance abuse and sexual activity 290
15.8 Substance abuse and unwanted pregnancy 291
15.9 Substance abuse and psychiatric disorders 292
15.10 Perinatal mood disorders 293
15.11 Spectrum of perinatal mood disorders 295
15.11.1 Postpartum blues 295
15.11.2 Postpartum psychosis 296
15.11.3 Postpartum depression (PPD) 296
15.12 Substance abuse and suicide risk in young girls 297
15.13 Impact of substance abuse on adolescent mother and offspring 297
15.14 Substance abuse and unintentional injuries 298
15.15 Prevention and treatment strategies specific for adolescent girls 299
15.15.1 Self-in-relation theory of women development 299
15.15.2 Social-structural model 300
15.15.3 Theory of gender and power 300
15.16 Treatment of comorbid psychiatric illness 301
15.17 Treatment of substance abuse in pregnant adolescents 303
15.18 Future of substance abuse treatment 305
15.19 Conclusions 305
16 Prescription stimulant and other substance abuse in college students 309
16.1 Introduction 309
16.2 Alcohol 310
16.2.1 Prevalence and demographic features 310
16.2.2 Consequences 311
16.2.3 New methods of ingestion 311
16.2.4 Prevention and treatment 312
16.3 Nicotine 313
16.3.1 Treatment 314
16.4 Marijuana 315
16.4.1 Consequences 315
16.4.2 Association with other conditions and implications for prevention and treatment 316
16.5 Cocaine 316
16.6 Prescribed stimulants 317
16.6.1 Associations/risk factors for misuse and diversion 319
16.6.2 Prevention and treatment 319
16.7 Conclusions 320
17 Sports doping by adolescent athletes 325
17.1 Introduction 325
17.2 Protection for consumers 327
17.3 Definitions 328
17.4 Anabolic agents 328
17.4.1 Epidemiology 329
17.4.2 Effects 330
17.4.3 Adverse effects 330
17.4.4 Use of additional or concomitant doping agents with AAS 331
17.4.5 Prevention 332
17.5 Dihydroepiandrostenedione (DHEA) 332
17.6 Androstenedione 333
17.7 hGH 333
17.8 Gamma hydroxybutyrate (GHB) 334
17.9 Clenbuterol 334
17.10 Creatine 335
17.11 Stimulants 337
17.11.1 Ephedrine 337
17.11.2 Caffeine 338
17.12 Blood doping and erythropoietin (EPO) 338
17.13 Miscellaneous sports-doping agents 339
17.14 Conclusions 340
18 Prenatal drug exposure: Maternal and fetal issues 347
18.1 Introduction 347
18.2 Screening and diagnosis 349
18.3 Alcohol 350
18.4 Tobacco 352
18.5 Marijuana 353
18.6 Opioids 354
18.7 Cocaine 357
18.8 Methamphetamine/amphetamines 358
18.9 Benzodiazepines 359
18.10 Inhalants 360
18.11 Conclusions 360
Section IV: New challenges and policy 363
19 New drugs of abuse in the 21st century 365
19.1 Introduction 365
19.2 Cannabinoids 365
19.3 Stimulants 367
19.4 Dissociative anesthetics 369
19.5 Hallucinogens 370
19.6 Conclusions 371
20 Estimating the societal burden of substance abuse: Advantages and limitations of current methodologies 373
20.1 Introduction 373
20.2 The cost-of-illness (COI) approach 374
20.3 What components drive the costs of abuse for each substance? 376
20.3.1 Cigarette smoking 376
20.3.2 Alcohol 378
20.3.3 Illegal drugs 379
20.4 Variations and controversies 382
20.4.1 Revisiting costs of crime 383
20.4.2 Including domestic violence, child abuse, and neglect 384
20.4.3 Including intangible costs of dependence and death 385
20.4.4 Cost offsets 386
20.4.5 Imperfect rationality 387
20.5 Conclusions 387
21 The pros and cons of legalization 393
21.1 Introduction 393
21.1.1 Difficult policy choices 395
21.2 Current policy: Prohibition 396
21.3 The effects of drug legalization 399
21.3.1 Product regulation 399
21.3.2 Availability to youth 400
21.3.3 The monetary and human costs of enforcement 402
21.3.4 State-level versus nationwide legalization 403
21.4 Middle paths and alternative approaches 403
21.4.1 Decriminalization 404
21.4.2 A kinder, gentler prohibition 404
21.4.3 Embracing harm reduction 405
21.5 Conclusions 406
22 Internet resources and treatment facilities 409
22.1 Informational websites 409
22.2 Treatment center websites 410
Section V: Acknowledgments 415
23 About the editors 417
24 About the Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine 419
24.1 Mission and service 419
24.2 Research activities 419
24.3 Contact 420
25 About the National Institute of Child Health and Human Development in Israel 421
25.1 Mission 421
25.2 Service and academic activities 421
25.3 Research activities 421
25.4 National collaborations 422
25.5 International collaborations 422
25.6 Targets 422
26 About the book series Health, Medicine and Human Development 425
Index 427