ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03729.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper presents national estimates of alcohol consumption and DSM‐IV alcohol abuse and dependence in the United States, Fifty‐nao percent of the adults surveyed were classified as current drinkers and nearly 9.0% met criteria for DSM‐IV akohol abuse or dependence. Greater percentages of males and whiles were classified as current drinkers and as alcohol abusers or dependent, compared with females and non‐whites., respectively. There is a need for future epidemiological research to collect belter data on drinking patterns as an aid to interpreting socio‐demographic differentials and to estimate more precisely the association between alcohol consumption and abuse and dependence in multivariate statistical environments. The critical need to examine the unprecedented reversal of the abuse‐to‐dependence ratio resulting from the application of the DSM.‐IV classification is emphasized. The role of future longitudinal alcohol epidemiological research in elucidating the initiation and maintenance of consumption patterns and alcohol use disord

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03730.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractIn this article it is argued that long‐term benzodiazepine (BZD) users can be classified into four broad groups, namely medical, daytime, night‐time and polydrug users. Although the groups are not exhaustive or mutually exclusive, such a classification may go some way to clarify our understanding of the complex psychological and sociological phenomena involved in long‐term consumption of

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03731.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractCigarette smoking has for years been declining slowly in a number of major Western countries. It nevertheless remains highly prevalent, with one‐quarter to one‐third of adults being current smokers in the USA and Britain, and only some 40 per cent of those who have ever smoked cigarettes regularly have given up. Smoking is increasingly becoming a marker for deprivation and for a stressful life‐style, and is also associated with consumption of other drugs. There is abundant and convincing evidence that, far from being confined to a minority of problem users, high levels of dependence on tobacco are experienced by a majority of smokers in the general population, with an onset early in the smoking career. The rewards which underpin continued smoking are unclear, but it may be that avoidance of the unpleasantness of not smoking is more significant than positively rewarding ef

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03732.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper focuses on the prevalence and profile of opiate use, primarily heroin, in the United States and Europe. Methods include representative population surveys, which understate prevalence, and targeted approaches, which reflect more problematic use. In the United States and Europe, the lifetime prevalence of opiate use reported in surveys remained stable over the 1980s (around 1%), though young adults report higher rates. Estimates for the early 1990s suggest that the prevalence of problematic heroin use in the United States was double the average for western Europe. However, in a few European countries prevalence is now approaching that of the United States. Rates in major cities are considerably higher, especially in the north‐east and south‐west of the United States. Higher prevalence is often, although not always, associated with socio‐economic deprivation. An important trend away from injecting is observed, notably in some European countries. Heroin availability and use, as well as serious heroin‐related consequences, are increasing again in many European countries after an apparent pause in the mid‐1980s. They are also increasing in parts of the United States. Heroin remains a public health priority, especially among vulnerable populations, including young people in central and easte

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03733.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe use of stimulants for recreation purposes has increased considerably during the 20th century. Cocaine was first considered to be a drug of potential abuse during the First World War but was only perceived as a serious threat when it became widely used in socially and economically deprived urban areas of the USA in the 1980s. Use of amphetamines was common among certain occupational groups as a means of remaining alert until the 1950s, when they were seen to be abused by a small minority of recreational users. Controls were then introduced in most developed countries. The public health issue of stimulant use is that of finding a balance between the prevention of serious social or personal harm caused by abuse of these drugs while not impeding their beneficial use.

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03734.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis overview discusses the five papers covering demographic and prevalence issues in terms of the commonalities and differences across psychoactive substances, particularly as they pertain to the relationship between demographic factors and the prevalence of substance abuse. This overview also concerns itself with gaps in knowledge, methodological issues and future directions for research. It begins with some basic definitions and fundamental questions. A brief review of the salient points of each paper is then provided, followed by a more synthetic discussion of methodological and theoretical issues. It closes with some speculative ideas about the meaning of demographic variables for an understanding of substance abuse.

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03735.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractAlcohol dependence is considered to be divisible into two types (although the divisions between these are indistinct). These are psychological dependence, in which the rewarding effects of alcohol play a primary role, and chemical dependence, in which adaptive changes in the brain initiate punishing effects on withdrawal of alcohol, and suppression of these becomes the primary motive for using the drug. The neurochemical basis for the rewarding effects of alcohol may be the potentiation of GABA at GABAAreceptors (causing relaxation) and release of dopamine from mesolimbic neurones (causing euphoria). The adaptive changes which cause the alcohol withdrawal syndrome are not known for certain, but alterations in GABAAreceptors, NMDA receptors and voltage‐operated calcium channels all have a claim. However, it is distinctly doubtful whether these all contribute to the negatively reinforcing effects of alcohol that are important in chemical dependence, although they may be important in other pathological effects of alcohol abuse. Current research badly needs better communication between basic scientists and clinicians to establish research goals and to improve current model

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03736.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe indications for the benzodiazepines include anxiety, insomnia, muscle spasm and epilepsy and each disorder has a variety of biological substrates. Limbic structures and the neurotransmitters noradrenaline, 5‐HT and GABA have all been implicated. Benzodiazepines act on alloosteric receptor sites and potentiate the actions of GABA in modulating chloride ionophores across nerve membranes. These effects can be blocked by the benzodiazepine antagonist, flumazenil. The molecular pharmacology of the benzodiazepine‐GABA‐chloride receptor is complex, with a wide range of different subunits. Animal models of dependence have suggested that the changes associated with long‐term benzodiazepine use are related more to receptor‐effector coupling than to the receptor characteristics themselves. Thus, benzodiazepine agonists on long‐term use lose their efficacy, antagonists become partial inverse antagonists, and inverse agonists increase in efficacy. Various clinical implications are explored, including the use of flumazenil to prevent and to treat benzodiazepine withdrawa

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03737.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThere is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the “rewarding” properties of nicotine, which serve to reinforce drug‐seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic rece

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03738.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY