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Quit Marijuana The Complete Guide

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Quit Marijuana The Complete Guide Summary


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Opioid Peptides Cannabinoids and Cocaine and Amphetamine Regulated Transcript

The appetite-stimulating effect of marijuana in humans has been well known for centuries 38 . Endogenous cannabinoids, in particular anan-damide, increase appetite and food intake via the activation of specific receptors known as CB1 39 , which are expressed in hypothalamic and central areas involved in the control of feeding behaviour 40, 41 . In fact, CB1 receptor mRNA is co-expressed with CRH, cocaine- and amphetamine-regulated transcript (CART), melanin-concentrating hormone (MCH) and prepro-orexin 42 . CB1 deletion in mice determines a decrease in body weight and fat mass, coupled with hypopha-gia 41, 42 . Interestingly, since both NPY and AgRP knockout models do not induce a lean phe-notype, likely due to the existence of redundant anabolic signals 6 , the experimental demonstration of lower body mass in CB1 receptor knockout mice strongly suggests a crucial role of endo-cannabinoids in the regulation of food intake and energy balance 41,42 . Notably, cannabinoids regulate...

Marijuana Cannabis sativa

Marijuana is an herb with several potential medicinal properties, including antiepilep-tic effects. It was first used for the treatment of epilepsy in the nineteenth century. The plant contains approximately 60 active substances cannabinoids, including THC (delta-9-tetrahydrocannibinol), the main chemical responsible for the mental effects of the drug and CBD (cannabidiol). Specific receptors for cannabinoids are located throughout the brain in areas that modulate seizure activity. Several small studies have examined these chemicals in various models of epilepsy and in various animal species. THC has variable effects, being antiepileptic in some models and forms of epilepsy (e.g., partial epilepsy), but with evidence that it can provoke seizures in inherited generalized epilepsies (9). Studies using CBD which does not cause a high seem to indicate it is more purely anticonvulsant. Several small double-blind human studies of CBD in epilepsy found an insignificant reduction in seizures...

Chronic Marijuana toxicity

Marijuana is an oily, dried fibrous material obtained from the Indian hemp plant, Cannabis sativa. Delta-9-THC is the psychoactive component. Hashish (smoked in pipes) and hashish oil (mixed with tobacco and smoked) All are Cannabis derivatives that contain higher concentrations of THC.


Marijuana refers to the dried-out leaves, flowers, stems, and seeds of the hemp plant, Cannabis sativa. The plant is a common weed that grows freely in most areas of the world. Marijuana, also known as cannabis, is also probably the most commonly used, abusable substance in the world, with the U.N. World Drug Report (1997) estimating 140 million daily users. It is most frequently smoked in small, hand-rolled cigarettes called joints (Schwartz, 2002). Alternatively, users employ regular pipes or water pipes called bongs. The resin from the flowering tips, hashish, is more potent and may also be smoked (Abel, 1980). Marijuana can also be ingested usually this occurs when it's baked into lipid-rich foods, such as brownies. Peak popularity occurred in the late 1970s, then steadily declined until 1992. Since that time, marijuana's use has been on the rise, and whether its current level of use has reached a plateau phase is still a subject of debate. Marijuana has many purported uses in...


Numerous studies have been undertaken to examine the effects of cannabis on driving. One large meta-analysis of more than 150 studies showed that cannabis impairs the skills important for driving, including tracking, psychomotor skills, reaction time, and performance, with the effects most marked in the first 2 h after smoking and with attention, tracking, and psychomotor skills being affected the most (68). The study also showed that impairment is most marked in the absorption phase as opposed to the elimination phase and that frequent cannabis users become less impaired than infrequent users. These are, for the most part, older studies, done during the 1970s. Impairment is dosage dependent, and externally observable symptoms (e.g., impairment of psychomotor skills or the impression of absent-mindedness), disappear quickly during the early elimination phase. More recent studies (69) conducted with volunteer marijuana smokers who were actually driving found that the main effect of...


The potent anti- nociceptive and antihyperalgesic effects of cannabinoid agonists in animal models of acute and chronic pain, the presence of cannabinoid receptors in pain- processing areas of the brain, spinal cord and periphery and evidence supporting endogenous modulation of pain systems by cannabinoids, provide support that cannabinoids exhibit significant potential as analgesics. Fifteen of eighteen randomized controlled trials examining cannabinoids in the treatment of pain have demonstrated a significant analgesic effect. Table 9.3 presents further detail. Cannabinoid agents tested included synthetic analogs as well as cannabis and cannabis-based extracts. These agents were tested in a number of pain conditions. Taken together, the evidence supports that cannabinoids exhibit a moderate analgesic effect in neuropathic pain and cancer pain with preliminary evidence for action in other types of pain such as spinal pain and headache. In Canada there are four cannabinoid agents...

Psychiatric Disorders 601411 Schizophrenia

Cannabis related disorders Cannabis induced disorders The prognosis for an individual with an anxiety disorder is dependent on the category and severity of the disorder. However, with combined pharmacological and behavioral interventions, the outlook is moderate to good even with the most severe cases of GAD. To satisfy current unmet medical need, efforts are being focused on new chemical entities (NCEs) that have the efficacy of BZs but lack the associated adverse effects. Such agents include g-amino-butyric acid (GABAa) receptor subunit selective 'BZ-like' NCEs12 including neurosteroids (e.g., ganaxolone), direct acting GABAa agonists like gaboxadol, and newer approaches to anxiety including cannabinoids, metabotropic glutamate receptor modulators, nicotinic receptor agonists, and modulators of the corticotrophin-releasing factor (CRF) family of receptors. DSM-IV-TR defines 11 classes of commonly abused substances (see 6.07 Addiction). These include alcohol, amphetamine and...

The Neurobiology of Substance Dependence

Brain abnormalities resulting from chronic use of nicotine, stimulants, opioids, alcohol, hallucinogens, inhalants, cannabis, and many other abused substances are underlying causes of dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). Most of the abnormalities associated with dependence resolve after detoxification, within days or weeks after the substance use stops. The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects for example, stress, the social context of initial opiate use, and psychological conditioning and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid-dependent.

Origins Of Drug Liking

For example, opioids and cannabinoids can inhibit activity in N-Ac directly, whereas stimulants such as cocaine and amphetamine act indirectly by binding to various DA transporters and either inhibiting the reuptake of DA into the VTA neurons (cocaine) or actively pumping DA out of the VTA (amphetamine) at its synapse with the N-Ac neurons (Kosten, 2002 Stahl, 1998). Since stimulation of the DA D2 receptor inhibits the cyclic AMP system, this increase in DA in the synapse leads to relative inhibition of the N-Ac neuron. The mechanism is more complex than this, however, since the D1 receptor has the opposite effect on the cyclic AMP system (e.g., it increases the amount of cyclic AMP) and both D1 and D2 receptors are present on the N-Ac neurons. The presumption is that the D2 receptor effects predominate perhaps simply due to more D2 receptors, or due to a higher affinity of the D2 than the Dt receptors for DA. Other substances may be even more indirect in their stimulation. For...

Neuronal Nicotinic Receptor Agonists

The incidence of smoking is high in patients with schizophrenia, a rate at least three times higher than the general population. In fact, nicotine appears to produce a modest transient improvement in cognitive and sensory deficits in these patients. It has been suggested that smoking in schizophrenia represents an attempt to self-medicate.39 However, these views must be interpreted with caution. Overall, schizophrenic patients have a high degree of comorbid abuse of a variety of substances including nicotine, alcohol, cannabis, cocaine, and amphetamine. Importantly, the rate of substance abuse is higher than in the general population for all of these substances in spite of the fact that such abuse is associated with poorer outcomes, exacerbation of positive symptoms, increased hospitalization, and increased frequency of homelessness. This increased propensity to abuse a variety of substances regardless of consequences suggests that there may be a disregulation of reward systems in...

Cultural and Social Change

In recent centuries, political, commercial, and technical advances have influenced the types, supply, cost, and availability of psychoactive substances, along with modes of administration (Westermeyer, 1987). International commerce, built on cheaper and more efficient transportation, and increasing income have fostered drug production and distribution. Increasing disposable income has resulted in greater recreational intoxication (Caetano, Suzman, Rosen, & Voorhees-Rosen, 1983). Development of parenteral injection for medical purposes was readily adapted to recreational drug self-administration in the mid-1800s, within several years of its invention. Purification and modification of plant compounds (e.g., cocaine from the coca leaf, morphine and heroin from opium, and hashish oil from the cannabis plant) produced substances that were both more potent and more easily smuggled and sold illicitly. Laboratory synthesis has produced drugs that closely mimic naturally occurring...

Patterns of Psychoactive Substance

Socially sanctioned, episodic psychoactive substance use may involve heavy use, with marked intoxication or drunkenness (Bunzel, 1940). In a low-technology environment, this pattern may cause few problems, although psychotomimetic drugs such as cannabis can cause toxic psychosis (Chopra & Smith, 1974). In a high-technology environment, with modern methods of transportation and industrial machinery, intoxication even at mild traditional levels may be life threatening (Stull, 1972). Binge-type alcohol problems include delirium tremens, fights, sexually transmitted disease, and falls.

History Of Substance Abuse Treatment

Beginning with Galenic medicine, a key strategy has been to identify certain syndromes as having their etiology in alcohol and drug abuse. Once the etiology is determined, the specific treatment (i.e., cessation of substance abuse) can be prescribed. Examples of such substance-associated disorders include delirium tremens (i.e., alcohol and sedative withdrawal), withdrawal seizures, morphinism (i.e., opioid withdrawal), cannabis-induced acute psychosis, stimulant psychosis, and various fetal effects, such as fetal alcohol syndrome. Thus, description of pathophysiological and psychopathological processes, together with diagnostic labeling, has been a crucial historical step in the development of modern assessment and treatment for substance use disorders (Rodin, 1981).

Social And Selfhelp Movements

Abstinent societies not tied to specific religions began to appear in the 18th and 19th centuries. Examples include the Anti-Opium Society in China and the Women's Christian Temperance Union in the United States. These groups engaged in political action, public education, social pressure against addiction or alcoholism, and support for abstinence. These led eventually to prohibition movements that sought legal strictures against the production, sale, and or consumption of psychoactive substances outside religious or medical contexts. In Asia, these movements began against tobacco (which was viewed in the 1600s and 1700s as a slothful habit associated with political sedition) and then later changed to oppose primarily opium. In Northern Europe and the United States, prohibition laws first involved opiates and cannabis but later

Trends In Treatment And Prevention

This approach is not extinct, as exemplified by the frequent recommendation in the 1970s that alcoholics substitute cannabis smoking for alcohol. Currently, methadone is used for chronic opiate addicts who have failed attempts at drug-free treatment. Despite aversive selection factors, methadone maintenance patients tend to do well as long as they comply with treatment. Chopra, G. S., & Smith, J. W. (1974). Psychotic reactions following cannabis use in East Indians. Arch Gen Psychiatry, 30, 24-27.

Descriptive Epidemiology of Herbal and Vitamin Poisonings

The most popular herb sales in the United States include Echinacea (10 ), garlic (10 ), goldenseal* (7 ), ginseng (6 ), Ginkgo (4.5 ), and saw palmetto (4.4 ). * Goldenseal is often used illicitly in unsuccessful attempts to disguise urinary marijuana (THC) metabolites. There are no toxicologic databases on herbal and vitamin toxicity in the United States. In Hong Kong, herbal medicine toxicity accounts for less than 1 of all acute hospital admissions, and Western medicine toxicity and drug-drug interactions account for 4.4 of all acute hospital admissions. Fatalities have resulted from megadoses of the fat-soluble and lipophilic (stored in liver and brain) vitamins A, D, and E and therapeutic (homeopathic) doses of niacin and tryptophan.

Hair Head and Pubic 51 Forensic Evidence

Hair is most commonly sampled to detect body fluids or retrieve foreign hairs or particles. It has been known for many decades that numerous ingested, prescribed, and illicit drugs (e.g., barbiturates, amphetamines, opiates, cocaine, benzodiazepines, y-hydroxy butyrate, and cannabis) are deposited in the hair (44). Although toxicology of hair was originally used to detect drugs that had been repeatedly ingested, recent advances in analytical techniques have meant that toxicology may be useful after single-dose ingestion as would occur in a substance-facilitated sexual assault (45,46). This is particularly pertinent because complainants of possible drug-facilitated sexual assaults frequently do not report the incident expeditiously because of amnesia and or doubt about what might have happened, and drugs may be accessible to analysis for longer periods in hair compared to blood or urine (47). In addition, it may be used as a reference sample for DNA analysis.

Substance Induced Mood Disorder

Two broad categories of substances can be distinguished in this context. The first comprises substances with primarily psychoactive properties that are prone to abuse and can become addictive. This category includes alcohol opiates and related compounds such as ketamine barbiturates benzodiazepines and other central nervous system depressants stimulants, including amphetamines cocaine and related compounds such as methylenedioxymethamphet-amine (MDMA Ecstasy) phencyclidine (PCP) marijuana and hashish hallucinogens such as lysergic acid diethylamide (LSD) and mescaline inhalants and miscellaneous substances such as y-hydroxybutyrate (GHB). The second category comprises substances whose psychoactive properties are incidental to their main therapeutic effects. This category includes numerous medications used for acute and chronic nonpsychiatric conditions. With regard to psychoactive substance induced depression, Bakken and colleagues (2003) found that 48 of 241 substance abusers (age...

Epidemiology of Reproductive Toxicology

Antimicrobials, antiemetics, theophylline, caffeine, ethanol, and nicotine. From 15 to 25 of pregnant women report licit drug use (ethanol > nicotine), or illicit drug use (marijuana > cocaine > heroin), or have positive urine drug screens during pregnancy. Analgesics, vitamins, iron, antibiotics, theoph-ylline, and psychotropic medications account for 50 to 80 of all reported toxic ingestions by pregnant women.

Testing Programs in Occupational Settings

The five substances routinely tested for include marijuana, cocaine, amphetamines, opiates, and PCP. Other drugs, such as alcohol, may be added to the panel if suspected by the employer from objective evidence (i.e., slurred speech, alcohol on the breath). Keeping with the Rule of Fives, there are five situations in which drug testing is conducted (1) preemployment, (2) random, (3) postaccident, (4) probable cause, and (5) return to work follow-up. The employer may request testing for additional substances in the case of postaccident, reasonable suspicion, and return-to-work situations. In order to undergo this additional testing, the employee must be notified via an official Employee Drug Policy document. Recognizing the high prevalence of alcohol abuse, ethanol testing was mandated in a 1994 amendment. There are separate regulations for alcohol testing, including not requiring MRO participation.

Fungal Pathogens Including Emerging Fungi

Fungal infections occur with increasing frequency when neutropenia is prolonged (see below). In the past, most fungal infections were caused by species of Candida or Aspergillus. Candida are frequent colonizers of skin, oropharynx, and the gastrointestinal tract, and may cause localized or disseminated infection. Aspergillus spores are widespread in the environment and can also be nosocomial pathogens, particularly in relation to building construction. Sinus or airway colonization may become an invasive infection in the setting of neutrope-nia. Those with a history of marijuana use, gardening, farming, or construction work are at a higher risk for being colonized.

Caveats in Interpreting Electrophysiologic Data in Substance Abuse Research

Perhaps the most important aspect regarding the usefulness of EEG and ERP measures in substance abuse research is the issue of specificity. Namely, whether the electrophysiological changes observed are unique to the specific drug or condition tested. Most of the data available to date suggests that EEG and ERP measures have limited diagnostic specificity. For instance, acute administration of either ethanol, cocaine or marihuana all result in significant increases in alpha activity (Lukas et al., 1986, 1990, 1991, 1995), these increases are not only indistinguishable from each other but are also similar to those observed during transcendental meditation (Lindsley, 1952 Brown, 1970 Wallace, 1970). Given the association between alpha activity and pleasurable states, these findings suggest that the drug-induced increases in alpha activity represent a neurophysiologic response associated with reinforcement in general. Even though electrophysiological measures are not always specific...

Cytokine Peptide Interactions

There has also been significant interest in the proinflammatory cytokine up-regulation of gp 130 molecules and the suppressors-of-cytokine-signalling (SOCS) protein family members in brain. Other hypothalamic systems such as the endogenous cannabinoids, which modulate energy balance, could also be involved in wasting and cachexia 38 . As mentioned, the brain melanocortin signalling system also may have an important contributory role 24-26 .

Scope and Context of the Issue

For millennia mankind has sought relief from pain by using medicines. Ancient texts refer to the use of many herbal remedies for pain. In the first century Emperor Claudius' personal physician recorded detailed instructions on the preparation of opium and Galen recommended the juice of the poppy for the relief of pain in older persons. Cannabis was a remedy with known pain relieving effects in use in Ancient China 1 , Persia, India, Egypt, Greece and Rome. The bark of the willow (from which aspirin is derived) was one of the many herbal remedies used by Sumerian, Egyptian, Greek and Roman physicians. In Hippocratic writings it was praised for combating the pains of childbirth and fever 1 .

The Evidence for Prescription Drug Use in the Management of Chronic Pain

Despite significant developments in pharmacological technology over time, very little has changed with regards to drug options for the management of pain. Derivatives of the poppy and the bark of the willow continue to play a prominent role. Cannabinoids have continued to be used as traditional remedies in many parts of the world and, with increasing evidence for analgesic and other therapeutic effects, are now receiving increased attention in Europe and North America 2-5 . The main additions to the pain therapists ' drug armamentarium include members of the antidepressant and anticonvulsant groups of drugs, and topical preparations (applied directly to the painful part), the latter supported by evidence identifying peripheral mechanisms of chronic pain. Recent reviews have identified several key groups of medication for which there is high quality evidence supporting efficacy in the management of chronic pain 6-9 . This evidence has been used to develop recommendations and treatment...

Initial Evaluation Of The Patient With Substance Use Disorders

Team and be used to develop the safest possible treatment plan. The clinician should ask about specific illicit substances such as heroin, cocaine, marijuana, and the club drugs (see below). For taking a history of alcohol use, some clinicians have suggested the use of the CAGE questionnaire (Ewing, 1984) 1. Can you cut down on your drinking 2. Are you annoyed when asked to stop 3. Do you feel guilty about your drinking 4. Do you need an eye-opener when you wake up in the morning One should also ask about sedative or stimulant use, whether prescribed or nonprescribed, and any dietary supplements or herbs the patient may be taking. A substance abuse review of systems, focusing on renal, cardiac, gastrointestinal, and, for HIV patients especially, neurological symptoms, is essential. Other points of inquiry are the date the substance was first used patterns, amount, and frequency of use and routes of administration and reactions to the use. The time of last use is important to know to...

Historical Context

In 1964 the notorious Pranksters drove cross-country in a Day-Glo bus, ostensibly to see the New York World's Fair, but it became instead a creative adventure. Cassady drove the bus, and its riders dropped acid and smoked marijuana along the journey, which was filmed for posterity. The bus became a metaphor for living your art, and the

Drugdrug Interactions

Alcohol consumption has been shown to significantly increase the blood serum level of abacavir by competing for alcohol dehydrogenase (McDowell et al., 2000) however, with chronic use, alcohol can induce CYP 3A4 and may decrease levels of some antiretrovirals (Caballeria, 2003). Ritonavir, and possibly other protease inhibitors, can inhibit the metabolism of alprazolam, which can lead to oversedation and respiratory depression if this drug is being abused. Inhaled marijuana has been shown to decrease the bioavailability of indinavir and nelfinavir, although the precise mechanism is unknown (Kosel et al., 2002).

New Research Areas

The ability of marijuana to stimulate appetite in humans has been well known for centuries.19 Administration of cannabinoids, the active ingredients in marijuana, has been established to stimulate food intake in animal models of feeding. Central and peripheral administration of anandamide (Figure 9), one of the major endocannabinoids, also increases food intake in preclinical models. The cannabinoid receptor 1 (CB1) is present in brain regions known to control food intake. Cannabinoid-induced feeding can be antagonized by the use of CB1 antagonists and starvation-induced feeding can be reduced by the administration of CB1 antagonists. Interestingly, CB1 knockout mice are leaner than wild-type controls primarily due to decreased food intake and lipogenesis in white fat during early postnatal development. In older animals, increased peripheral energy expenditure appears to be the predominant defense against increased adiposity in the knockout animals. The CB1 receptor is expressed...

Physiological Effects

Cannabis intoxication commonly heightens the user's sensitivity to external stimuli, thus making colors seem brighter and smells more pungent. It also distorts, sometimes severely, the user's sense of time. The term temporal disintegration (Mathew, Wilson, Humphreys, Lowe, & Weithe, 1993) has been coined to describe this slowing of subjective time after use of marijuana. In addition, at least in low doses, marijuana causes mild euphoria and feelings of relaxation. It is also know to increase appetite. There is some controversy over whether individuals intoxicated with cannabis pose a hazard, as they seem to be attracted to thrill-seeking behavior and are usually subdued. Some people have argued that individuals who smoke marijuana are less likely to drive fast however, reaction time to complex and unforeseen situations is slowed, and muscle strength and hand-eye coordination is decreased. Because it delays reaction time, alters time perception, and for many other reasons, marijuana...

Studies in MS and Other Conditions

The biologic effects of the chemicals in marijuana, known as cannabinoids, have been extensively investigated. These chemicals bind to proteins in the central nervous system (CNS) that decrease nerve cell activity. These proteins are known as CB1 receptors. Theoretically, binding to CB1 receptors could decrease some multiple sclerosis (MS)-associated symptoms, such as pain and spasticity. Also, cannabinoids bind to another type of protein known as CB2 receptors. Binding to these proteins, which are present on immune cells, may mildly suppress the immune system and could thus potentially slow down the disease course in MS. Other effects of cannabi-noids, including antioxidant properties and inhibitory effects on a harmful process known as excitotoxicity, could also theoretically be beneficial for MS. The effects of marijuana, THC, and nabilone have been studied in many diseases, including MS. Some of the recent interest in marijuana was generated by a 1999 report by the National...

Mechanism of Action

Several lines of evidence support the hypothesis that GHB is a neurotransmit-ter. GHB temporarily suppresses the release of dopamine in the mammalian brain. This is followed by a marked increase in dopamine release, accompanied by the increased release of endogenous opioids (Hechler, Goebaille, & Maitre, 1992). GHB also stimulates pituitary growth hormone (GH) release, although the mechanism by which GHB stimulates GH release is not known. Dopamine activity in the hypothalamus stimulates pituitary release of GH, but GHB inhibits dopamine release as it stimulates GH release. While GH is being released, serum prolactin levels also rise in a similar, time-dependent fashion. GHB has several different actions in the CNS, and some reports indicate that it antagonizes the effects of marijuana (Galloway et al., 1997). The consequences of these physiological changes are unclear, as are the overall health consequences for individuals who use GHB.

Problemsolving process

In the course of therapy Gabriel and his parents redefine the rules that guide their living together. Although Gabriel consumed cannabis several times after a self-imposed period of abstinence, the relationship to his father is more relaxed. The mother decides to stop work in the father's consulting business and takes up her profession as a seamstress again. At the same time the number of arguments between the parents regarding their own relationship increases. Both feel, however, that they can solve these marital problems themselves without therapeutic support.

Pharmacotherapeutic Considerations

For the management of certain subtypes of pain, Health Canada 18 has approved access to medical marijuana for sufferers of a number of specific subtypes of chronic pain. The use of cannabinoids, synthetic or naturally occurring, may be associated with the exacerbation of psychotic symptoms in persons with preexisting psychotic illness or with a vulnerability to developing psychosis, and may further be associated with the relapse into psychosis in persons with schizophrenia. The use of cannabinoids should be conducted with great caution in individuals with a history of mental illness.

Psychiatric Comorbidity And Sequelae

The most frequent co-occurring substance use disorder is alcoholism 29 of cocaine abusers have a current alcoholism diagnosis, and 62 a lifetime alcoholism diagnosis (Rounsaville et al., 1991). These findings are alarming considering that individuals with comorbid cocaine and alcohol use disorders manifest a more severe form of cocaine dependence, and comorbid alcohol abuse is associated with poorer retention in treatment and poorer treatment outcomes for both disorders (Brady, Sonne, Randall, Adinoff, & Malcolm, 1995). Cocaine use disorders also are common among opioid abusers. In addition, 66 of methadone-maintained patients abuse cocaine (Kosten, Rounsaville, & Kleber, 1987), and 75 of the heroin addicts admitted to methadone programs identify cocaine as their secondary drug of abuse (New York State Division of Substance Abuse Services, 1990). A national survey of 15 clinics (General Accounting Office, 1990) revealed continued cocaine use in as many as 40 of patients after 6...

Obstetric And Developmental Effects

A stable, negative, cocaine-specific effect on language functioning was found through age 7, after controlling for sex, age, prenatal exposure to alcohol, marijuana and tobacco, and over 20 other medical and demographic factors (Bandstra et al., 2002). Similarly, Azuma and Chasnoff (1993) reported lower

Distinguishing Medical And Nonmedical Use Of Benzodiazepines

What is the pattern of the controlled substance use Typical medical use of controlled substances is similar to the use of penicillin or aspirin, in that it occurs in a medically reasonable pattern to treat an easily recognized health problem other than addiction. Typical use of nonmedical drugs (e.g., alcohol, marijuana, or cocaine), in contrast, takes place at parties or in other social settings. Medical substance use is stable and at a moderate dose level. Nonmedical use of a controlled substance is usually polydrug abuse at high and or unstable doses (Juergens & Cowley, 2003).

Medical Use And Abuse

Workplace drug testing is usually limited to identification of marijuana, cocaine, morphine-codeine, amphetamine-methamphetamine, and phencycli-dine (PCP). However, benzodiazepines and barbiturates may be added to the test panel. Laboratory positive test results for patients with legitimate prescriptions for benzodiazepines and barbiturates are reported to employers by medical review officers (MROs) as negative, as are other laboratory results that reflect appropriate medical treatment with other controlled substances (MacDonald, DuPont, & Ferguson, 2003).

Identification Of Problems Among Longterm Benzodiazepine Users

Medical and nonmedical substance use. Is the benzodiazepine dose the patient is taking reasonable Is the clinical response to the benzodiazepine favorable Is there any use of nonmedical drugs, such as cocaine or marijuana Is there any excessive use of alcohol (e.g., a total of more than four drinks a week, or more than two drinks a day) Are other medicines being used that can depress CNS functioning 2. Medical and nonmedical substance use. Is the dose of the benzodiazepine the patient is taking reasonable Is the clinical response to the benzodiazepine favorable Is there any use of nonmedical drugs, such as cocaine or marijuana Is there any excessive use of alcohol (e.g., a total of more than four drinks a week, or more than two drinks a day) Are there other medicines being used that can depress the functioning of the CNS

Defining Multiple Substance Use Diagnostic Approaches

Although there was a diagnostic category of mixed substance abuse in DSM-III (American Psychiatric Association, 1980, p. 179), there is no diagnosis of polysubstance abuse in DSM-IV-TR (American Psychiatric Association, 2000). There may not be many people who abuse multiple substances over time with clinically significant impact, for whom no one substance is sufficient to make formal abuse criteria. This is because one needs only to satisfy one of the four DSM-IV criteria to pass the threshold for a substance abuse diagnosis related to that particular substance. However, it is conceivable that one could meet a criterion for substance abuse based on use of multiple substances, but not on one in particular. For example, a person could have two arrests for driving under the influence, one for alcohol and the other for cannabis, in the same year.

Descriptive Approaches

Most broadly, the literature frequently describes polydrug use or poly-substance use. This nondiagnostic designation generally describes the use of multiple substances rather than framing the use and its effects in clinical terms, which is the intent of diagnosis. As such, polydrug use describes, at minimum, the use of multiple substances, whether licit or illicit. In the treatment research literature, polydrug use is often used to describe the lifetime number of drugs regularly used to a threshold SUD, in addition to the index substance (Ball, Carroll, Babor, & Rounsaville, 1995 Feingold, Ball, Kranzler, & Rounsaville, 1996). However, in other than addiction or mental health treatment settings, the expressions polysubstance use or polysubstance abuse are frequently meant to describe the use by subjects of as few as two substances, such as cocaine and alcohol, alcohol and cannabis, or opiates and cocaine (Ross, Kohler, Grimley, & Bellis, 2003). In a more differentiated...

Population Based Studies

Adolescent substance users are a subgroup who have been identified as high risk for concurrent polysubstance use, and with that, progression to hazardous use, abuse, or dependence (Brook, Brook, Zhang, Cohen, & Whiteman, 2002). Compared with older age groups, younger users in treatment settings are more likely to report polydrug use (Substance Abuse and Mental Health Services Administration SAMHSA , 2003b). The NHSDA oversamples subjects who are from 12 to 34 years old, offering community substance use data on adolescents who are not typically covered in other national surveys (Kandel et al., 1997). Although males overall are more likely than females to use or be dependent upon alcohol, cannabis, or cocaine, Kandel and colleagues (1997), using NHSDA data to determine abuse and dependence by proxy, demonstrated that these gender differences for rates of use and of dependence rates among users are largely attenuated among adolescents. Adolescent girls who use alcohol or illicit drugs...

Substance Intoxication Delirium

The list of drugs of abuse that can produce delirium is extensive. Some such agents have enjoyed a resurgence after years of declining usage. These include lysergic acid diethylamide, psilocybin (hallucinogenic mushrooms), heroin, and amphetamines. Other agents include barbiturates, cannabis (especially dependent on setting, experience of the user, and whether it is laced with phencyclidine superweed or heroin), jimson-weed (highly anticholingeric), and mescaline. In cases in which intravenous use of drugs is suspected, HIV spectrum illness must be ruled out as an etiological agent for delirium.

Introduction Analysis Of Urinary Drugs In Clinical And Forensic Toxicology

Clinical and forensic toxicology is concerned with the detection, identification, and measurement of toxic compounds and their metabolites in human body fluids and tissues. Most often the toxic compounds are drugs taken either accidentally or intentionally in quantities sufficient to cause an adverse reaction or death. Analysis and identification of a possible drug or drug combinations, toxicological drug screening and confirmation should encompass as many different classes of drugs as possible. The most important classes being salicylate, paracetamol, antiepileptics, antidepressants, neuroleptics, hypnotics (benzodiazepines, barbiturates, diphenhydramine), digoxin, and theophylline, as well as many illicit drugs, such as opiates, methadone, D-lysergic acid diethylamide (LSD), cocaine, and or its major metabolite benzoylecgonine, cannabinoids and amphetamines. Currently, urinary drug monitoring has established itself as the basis of clinical and forensic toxicology. It is also the...

Genetic And Family Studies

Much of the evidence for the heritability of the general and specific vulnerability for SUD is taken from studies of familial aggregation. Bierut and colleagues (1998) compared siblings of probands with alcohol dependence and those of a control group for the presence of lifetime SUDs. Siblings of alcoholic probands were not only more likely to have a lifetime alcohol use disorder, but they also had an increased risk of cannabis, cocaine, and nicotine dependence. Fifty percent of the alcohol-dependent siblings of alcohol-dependent probands had an additional diagnosis of cannabis and or cocaine dependence. What is compelling with respect to understanding the risk for multiple substance dependence is that the siblings of cannabis-dependent probands had an increased risk of cannabis dependence, siblings of cocaine-dependent probands had an increased risk for cocaine dependence, and siblings of habitual smokers were at higher risk for nicotine dependence (Bierut et al., 1998). In another...

Opioid Dependence and Opioid Maintenance Treatment

Polydrug use is the norm among heroin users. In a study of 329 primary heroin users by Darke and Hall (1995), the most prevalent drugs used during the preceding 6 months were tobacco (94 ), cannabis (84 ), alcohol (78 ), benzodiazepines (64 ), amphetamines (42 ), cocaine (24 ), and hallucinogens (22 ) the mean number of drug classes used was 5.2. However, it appears that as they grow older, illicit drug users reduce their range of drugs Age is inversely correlated in IDUs with the number of current dependence diagnoses, and young males who are not in treatment, and who inject amphetamines, are at higher risk for polysubstance use (Darke & Hall, 1995 Darke & Ross, 1997). Cannabis Cannabis use among patients in methadone treatment programs has recently been investigated in an attempt to answer the practical question of whether cannabinoid-positive urine toxicology examinations predict poor treatment outcome. Both a recent Israeli study (Weizman, Gelkopf, Melamed, Adelson, &...

Adolescents Club Drugs and the Rave Scene

Ders, as well as attention-deficit hyperactivity disorder. Although club drugs originally got their name from nightclubs and raves, adolescents and young adults now use club drugs in both club and nonclub settings (Rosenthal & Solhkhah, in press). Overall, studies of typical MDMA users reveal high rates of multiple drug use (Parrott, Milani, Parmar, & Turner, 2001 Parrott, Sisk, & Turner, 2000 Rodgers, 2000 Schifano, Di Furia, Forza, Minicuci, & Bricolo, 1998). Among treatment seekers, heavy MDMA use is associated with increased psychopathology (Parrott et al., 2000 Schifano et al., 1998). In addition to use of alcohol and cannabis, the heavier the MDMA use, the more likely is the co-use of stimulants and hallucinogens (Scholey et al., 2004). MDMA as a sole drug of abuse is an uncommon phenomenon thus, it is a reasonable proxy for abuse of multiple substances (Rodgers, 2000).

The Scale of the Problem

In October 1999, the UK Department of Environment, Transport and the Regions completed a 3-years study into the incidence of drugs in road accident fatalities (66). There were a total of 1138 road user fatalities, including drivers, riders of two-wheeled vehicles (34 of them cyclists), passengers in vehicles, and pedestrians more than 6 tested positive for medicinal drugs, 18 for illicit drugs (mainly cannabis), and 12 for alcohol. In this study, urine was tested by immunoassay for the following drugs alcohol, amphetamines, methyl amphetamines (including ecstasy), cannabis, cocaine, opiates, methadone, lysergic acid diethylamide, benzodiazepines, and tricyclic antidepressants. The incidence of medicinal drugs likely to affect driving had not significantly changed from the 1985-1987 study (67). However, illicit drug taking in drivers had increased sixfold in percentage terms, and there was a comparable increase among passengers. In addition, an in- Cannabis 28 Cocaine

Other CAM Therapies

Homeopathy is a low-risk approach of uncertain effectiveness for sleep problems. Several supplements are promoted for insomnia. As discussed elsewhere in this book, melatonin may be beneficial, but in people with MS it is associated with a theoretical risk because of its immune-stimulating activity. 5-HTP, another supplement, has unclear effectiveness for insomnia and may be harmful. Marijuana has produced positive results in some studies. However, it also may cause significant side effects and is illegal in most states. Kava kava sometimes is recommended for insomnia, but most studies of this herb have actually only evaluated its effectiveness for anxiety. In any case, kava kava should be avoided because of possible liver toxicity.

Cannabinoid Receptors

The biological actions of exogenous and endogenous cannabinoids are brought about by the activation of two types of cannabinoid receptors, CB1 and CB2 (290,291). The implication of cannabinoids in pain mechanisms is related to the presence of CB1, but not CB2, receptors on DRG neurons (292,293). Synthesized in the somata, CB1 receptors are transported not only to the central terminals of sensory neurons in the spinal cord, where their activation inhibits the release of substance P (294), but also to the peripheral terminals of sensory neurons (295), where their activation interferes with nerve excitation by noxious stimuli (296,297). Although activation of CB1 receptors on peripheral and central vagal afferent pathways counteracts nausea and emesis, a particular aspect of GI discomfort (291), it is not yet clear whether cannabinoid receptor agonists have beneficial effects in visceral hyperalgesia. Owing to observations on somatic pain, it has been proposed that CB1 receptor agonists...

Drug Tolerance Dependence And Withdrawal

From a clinical standpoint, withdrawal can be one of the most powerful factors driving dependence and addictive behaviors. This seems particularly true for opioids, alcohol, benzodiazepines, nicotine, and to a lesser extent stimulants such as cocaine. For hallucinogens, cannabinoids, or inhalants, withdrawal Tolerance occurs because the brain cells that have receptors or transporters on them gradually become less responsive to the stimulation by the exogenous substances. For example, more opioid is needed to inhibit the cyclic AMP system in the N-Ac neurons, as well as to stimulate the VTA brain cells of the mesolimbic reward system to release the same amount of DA in the N-Ac. Therefore, more opioid is needed to produce pleasure comparable to that provided in previous drug-taking episodes. The mechanism for this reduction in response is related to the cyclic AMP coupling for opioids, but direct reductions in the number of receptors or increases in the number of transporters can...

Treatment Considerations

H., Begleiter, H., Crowe, R. R., Hesselbrock, V., Nurnberger, J. I., et al. (1998). Familial transmission of substance dependence Alcohol, marijuana, cocaine and habitual smoking. Arch Gen Psychiatry, 55, 982-988. Epstein, D. H., & Preston, K. L. (2003). Does cannabis use predict poor outcome for heroin-dependent patients on maintenance treatment Past findings and more evidence against. Addiction, 98, 269-279. Kandel, D., Chen, K., Warner, L. A., Kessler, R. C., & Grant, B. (1997). Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population. Drug Alcohol Depend, 44, 1129. Weizman, T., Gelkopf, M., Melamed, Y., Adelson, M., & Bleich, A. (2004). Cannabis abuse is not a risk factor for treatment outcome in methadone maintenance treatment A 1-year prospective study in an Israeli clinic. Aust NZJ Psychiatry, 38, 4246.

Disease Basis

Like the majority of central nervous system (CNS) disorders, the initial understanding of the factors causing schizophrenia was based on serendipity, in this instance, the finding that chlorpromazine, the first drug used for the treatment of the disease, was a dopamine (DA) receptor antagonist.3 Since then it has been well established that schizophrenia is a multifactorial disease involving both genetic and epigenetic factors7 that may also exist in several distinct subtypes. Identified risk factors for schizophrenia include winter birth low socioeconomic status cannabis use obstetric complications and intrauterine infection related to birth immigration living in a city (urbanicity) and the neighborhood cognitive social capital8 low intelligence quotient and a family history of the disorder. There is increasing data81 that schizophrenia can be associated with autoimmune diseases, e.g., celiac disease, acquired


Anthropological studies of preliterate societies have shown the almost universal use of psychoactive substances. Tribal and peasant societies of North and South America focused on the development of stimulant drugs (e.g., coca leaf, tobacco leaf, and coffee bean) and numerous hallucinogenic drugs (e.g., peyote). They used hallucinogens for ritual purposes and stimulant drugs for secular purposes, such as hard labor or long hunts. New World peoples discovered diverse modes of administration, such as chewing, nasal insufflation or snuffing, pulmonary inhalation or smoking, and rectal clysis (DuToit, 1977). African and Middle Eastern ethnic groups produced a smaller number of stimulants, such as qat, and hallucinogens, such as cannabis (Kennedy, Teague, & Fairbanks, 1980). Groups across Africa and the Eurasian land mass obtained alcohol from numerous sources, such as honey, grains, tubers, fruits, and mammalian milk. Certain drugs were also used across vast distances, such as opium...

Early History

Ingested medication in these first documents, especially for medicinal purposes. Mayan, Aztec, and Incan statues and glyphs indicated drug use for ritual reasons (Furst, 1972). Medieval accounts recorded traditional alcohol and drug use. Travelers of that era often viewed use patterns in other areas as unusual, aberrant, or problematic examples include reports of Scandinavian beserker drinkers by the English and reports by Crusaders of Islamic military units or assassins intoxicated on cannabis. Along with animal sacrifice and the serving of meat, the provision of alcohol, betel, opium, tobacco, or other psychoac-tive substances came to have cultural, ritual, or religious symbolism, including hospitality toward guests (Smith, 1965). Affiliation with specific ethnic groups, social classes, sects, and castes was associated with consumption of specific psy-choactive substances. For example, one group in India consumed alcohol but not cannabis, whereas an adjacent group consumed cannabis...


Representative Goldenseal is an herb frequently used as an astringent and to reputedly mask the presence of illicit drugs, especially marijuana, on urine screens. Goldenseal is, however, ineffective as an undetected adulterant and is easily detected by GC MS ( + drug test). Latin Hydrastis canadensis. Toxin Hydrastine. Antidote None.


In most settings, the primary purpose of drug testing is to identify individuals who are using illegal or illicit drugs. Falsely accusing someone of using drugs is highly problematic and undermines the testing program. Similarly, not being able to identify active drug users because of false-negative results renders a program of limited value. It does not deter use or identify users. This is so both for the emergency room physician wondering if the agitated patient used PCP, and for the consultant to the local college track team. For these situations, highly sensitive qualitative screening tests should be employed, even if this leads to some false-positive results. On the other hand, definitive tests should have the highest level of specificity They should exclude as many true negatives as possible. For nonusers who are subjected to drug testing, issues related to false-positive results are of great concern. Questions addressing which foods, prescribed medications, dietary supplements,...

Drug Therapy

The optimal therapeutic approach to anorexia should be aimed at counteracting its pathophysio-logic mechanisms. Therefore, considering their involvement in anorexia, cytokines represent the ideal therapeutic target. A series of animal studies support this approach by showing that intrahypo-thalamic IL-1 blockade results in amelioration of anorexia and improves food intake 48, 62 . In humans, cytokine therapeutic targeting is achieved by the use of agents that interfere with their synthesis and release. They include progestagens 63-65 , cannabinoids 66 , and corticosteroids 67 .

Topographic Mapping

Topographic maps of brain electrical activity are particularly useful as hypothesis-generating tools in that they provide a quantifiable measure of drug-related changes in activity across the entire scalp. By carefully examining and identifying new patterns of activity, new hypotheses and avenues of research can be developed. For example, recent findings of increased alpha activity in the frontal and frontal-central scalp regions of daily marijuana users (Struve et al., 1994, 1998) would have been missed if such studies exclusively investigated alpha activity in the occipital regions of the scalp, where alpha is normally most pronounced.

Club Drugs

Lematic in terms of HIV transmission, as the parties often go on for several days, with drug use and sexual activity being the primary objectives. Although some of these parties originally began as fund-raisers for HIV service organizations, most of these organizations have since distanced themselves from such functions and they have taken on independent lives oftheir own through magazines and Web sites. Drugs commonly used at circuit parties include MDMA, ketamine, gamma-hydroxybutyric acid (GHB), methamphet-amine, cocaine, marijuana, and alcohol (Bialer, 2002) The club drugs that are of the most concern in relation to HIV AIDS are MDMA, GHB, and metham-phetamine.

Drug Searches

Variable quantities of drugs, such as heroin, cocaine, cannabis, and amphetamine, may be packaged in layers of cellophane or in condoms. All searches for such drugs should be carried out in premises where there are full facilities for resuscitation (32a) in case significant quantities of the drugs leak into the bloodstream, resulting in acute intoxication and death from overdose (33). Other medical problems such as bowel obstruction may also occur.


Significant psychiatric comorbidity has been observed depression and personality disorder are the most frequent diagnoses. Polysubstance abuse is common in opioid addicts. Many are nicotine addicted, and many have serious alcohol-related problems as well. Benzodiazepine use is common and probably underestimated, because it may not be specifically assayed in urine specimens. Sporadic use of cocaine and other stimulants is common, as is the use of marijuana. A few opioid addicts also use hallucinogens or inhalants. der with water, heat it, and use cotton or a cigarette filter to block the entry of undissolved particles as the solution is drawn into the syringe. As a result, fibers enter the venous bloodstream and lodge in the lungs, where conditions become favorable for the development over time of pulmonary thrombosis (emboli arise at distant sites), pulmonary hypertension, and right-side heart failure. Opioid abusers are at further risk of compromised pulmonary function if they use...

David Mcdowell

Hallucinogens consist of a disparate group of psychoactive substances, and include 3,4-methylenedioxyamphetamine (MDMA), hallucinogens, ketamine, and marijuana. They differ in terms of administration, mechanism of action, and effect. In many cases, they are used by groups of younger people and are taken in various combinations with each other and other classes of substances, usually in social settings (often at raves see Bellis, Hale, Bennett, Chaudry, & Kilfoyle, 2000 or other parties). At some of these events, a substantial majority of rave participants are using MDMA, ketamine, gamma-hydroxy-butyric acid (GHB), or other drugs, such as marijuana and D-lysergic acid diethylamide (LSD). In addition, at times inhalants are used at these events (Lee & McDowell, 2003 McDowell & Kleber, 1994 Winstock, Griffiths, & Stewart, 2001). Polysubstance might be considered the norm at such events, with over 80 of participants using more than one substance (Boys, Lenton, & Norcross,...


Marijuana has been used since antiquity, and it can be found in numerous ancient texts. The oldest known reference to marijuana is in a 15th-century B.C. Chinese text on herbal remedy (Walton, 1938). Also, Assyrian cuneiform tablets from 650 B.C. that contain references to people smoking marijuana are generally regarded as obvious copies of much older texts, according to Walton. Although archeological findings in Berlin, Germany, suggest that marijuana was in Western Europe by 500 B.C., an exact date or extent of use is unknown. However, hemp-based clothing was widespread in central and southern Italy, and the intoxicating effects of marijuana were also recorded in Renaissance texts. In Europe, it was quite popular in 19th-century high society. In the United States, in the beginning of this century, it was popular principally in the West and was mostly associated with ethnic groups and jazz musicians. Marijuana's social stigma, epitomized in the now-popular classic cult film Reefer...


Marijuana withdrawal has been demonstrated in laboratory animals, as well as in humans, and is now well documented. Chronic heavy users of cannabis may experience some withdrawal in the form of irritability, general discomfort, disrupted sleep, and decreased appetite (Budney, Moore, Vandrey, & Hughes, 2003). This syndrome is not as painful as that with heroin, as dangerous as that The clinician is confronted with a wider range of marijuana users. At one end is the individual who uses the drug only rarely, but whose use is detected on a routine drug screen and brought to the clinician's attention, perhaps for an evaluation. Brief assessment, to make sure the problem is not more serious than it appears, is always necessary in this case. Subsequent follow-up, to ensure that the initial impression was correct, is part of a thorough assessment. In this instance, the user is usually embarrassed and repentant, and has no objection to future monitoring. Users who do not have a problem with...

Treatment Method

Marijuana is available in several forms. The main active constituent in marijuana, a chemical known as delta-9-tetrahydrocannabinol or THC, is available by prescription as a pill (dronabinol or Marinol). Sativex, an oral spray that contains THC and another marijuana constituent, cannabidiol, is available by prescription in Canada. A synthetic form of THC (nabilone or Cesamet) also is available as a pill in Canada, Europe, and Australia. Most simply, the leaf may be smoked or eaten. The resin of the plant, hashish, also may be smoked.

Journal Articles

Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature 2000 404 84-87. Baker D, Pryce G, Giovannoni G, et al. The therapeutic potential of cannabis. Lancet Neurol 2003 2 291-298. Bowling AC. Worthless weed or pot of gold Int J MS Care 2004 5 138,166. Clark AJ, Ware MA, Yazer E, et al. Patterns of cannabis use among patients with multiple sclerosis. Neurol 2004 62 2098-2100. Fox P, Bain PG, Glickman S, et al. The effect of cannabis on tremor in patients with profile in multiple sclerosis. Clin Exp Immunol 2005 140 580-585. Killestein J, Hoogervorst ELJ, Reif M, et al. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. J Neuroimmunol 2003 137 140-143. Vaney C, Heinzel-Gutenbrunner M, Jobin P, et al. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis a randomized, double-blind, placebo-controlled,...


Treatment Episode Data Set (TEDS Substance Abuse and Mental Health Services Administration, 2002) data also reveal the use of cocaine in combination with other illegal drugs. Marijuana, methamphetamine, and heroin were the secondary drugs of abuse most often mentioned in 1999 TEDS admissions for which cocaine was identified as the primary substance of abuse. Admissions for cocaine taken by routes other than smoking were more likely to be white males (29 ), followed by black males (23 ), white females (18 ), and black females (12 ). Admissions for smoked cocaine were more likely to be black


Phencyclidine, known as angel dust, is usually smoked, although it can be taken orally, intravenously, or by nasal inhalation. It is commonly used as an additive to other drugs, such as cannabis or LSD, and the symptoms and signs may vary greatly (49). At low doses, euphoria, relaxation, and an altered body image may occur, but at higher doses, there may be agitation, bizarre behavior, and a paranoid psychosis (50). Analgesia occurs, which may lead to self-injury. Physical effects include nystagmus (lateral and vertical), and with severe intoxication there is adrenergic stimulation with hypertension, tachycardia, flushing, hyperthermia, and cholinomimetic stimulation with sweating, hypersalivation, miosis, dystonia, ataxia, and myoclonus eventually resulting in coma, respiratory arrest, and circulatory collapse (51). Death may also result from intoxication or from violent behavior. Chronic effects of phen-cyclidine abuse include memory impairment, personality changes, and depression...

Clinical Samples

Comorbidity of various substance use and other mental disorders tends to cluster among certain subsets of the general population, such that more than half of the lifetime alcohol, drug, and mental disorders diagnoses can be found among about 14 of the population (Kessler et al., 1994). In any year, almost 59 of the community sample with an alcohol, drug, or other mental (ADM) disorder meet criteria for three or more lifetime ADM disorders (Kessler et al., 1994). Therefore, compared to the community, treatment settings that aggregate those with SUDs are also most likely to cohort people at the highest risk for multiple SUDs. This is borne out in large-scale family genetics studies. For example, in the Collaborative Study on the Genetics of Alcoholism (COGA), among 1,212 subjects with definite alcohol dependence, recruited from addiction treatment centers, 62 had an additional diagnosis of cannabis and or cocaine dependence (Bierut et al., 1998). Treatment Episode Data Set (TEDS) data...

Typologic Approaches

Alcohol, cocaine, marijuana, or opiate abuse or dependence. The authors found a consistent 60 40 ratio of Type A to Type B for each of the drug groups, suggesting clusters of personality characteristics that are independent of drug of choice. Similarly, in 370 patients attending treatment for alcoholism, cocaine, or opiate dependence, Ball and colleagues (1998) replicated the A-B classification and also found a 60 40 Type A to Type B ratio. Type A substance abusers had less multiple drug use, as well as an older age of onset, fewer years of heavy use, less family history of substance abuse, less impulsivity, and less severe substance abuse. Type B substance abusers tended to be more severe than type A abusers, scoring higher on the personality dimensions of neuroticism, novelty seeking, and harm avoidance. They also had a higher prevalence of multiple substance abuse, an earlier age of onset, more childhood psychiatric symptoms, higher incidence of all Cluster B personality disorders,...

Survivor Education

Their consumption to problem levels following traumatization. Some research does suggest that trauma survivors will respond to brief interventions targeting their drinking. Working with patients admitted to a hospital trauma center for treatment of injury, who screened positive for excessive alcohol use, Gentilello et al. (1999) demonstrated that a single 30-minute interview can reduce alcohol consumption in those with existing alcohol problems. Another study, of an intervention based on motivational enhancement (Miller & Rollnick, 1992), which addressed substance use problems in patients seeking emergency medical care, suggested that more than one contact may be important. Longabaugh et al. (2001) found that a 40- to 60-min-ute intervention, plus booster session, reduced consumption and was more effective in reducing alcohol-related negative consequences than standard care or a single-session intervention. In addition to these brief one-to-one interventions, it is possible that...

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