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Drug abuse hit the national headlines during the last half of the 1960s. By 1971 it had become "public enemy number one" and an all-out war was declared. Although there were a few notable successes—including one temporary triumph which was prematurely labeled a victory in 1973—by 1977 it had become clear that this war, like the War in Vietnam and the War Against Poverty, was not to be won. A new objective, more in keeping with the skepticism of the 1970s, was indeed needed. Drug abuse prevention was not like waging a war; it was like weeding a graden. The question remained, "What crop was to be harvested in the 1980s?"

"As the drug abuse epidemic evolves, so do the tools needed to understand and treat it. Accordingly, Epidemiology of Drug Abuse takes the long view, cogently outlining what the book calls ""the natural history of drug abuse"" and redefining its complex phenomena to reflect our present-day knowledge. Twenty-six eminent contributors discuss the state and future of the field, balancing the practical concerns involved in gathering drug abuse data with the ethics of using the information. - Current thinking on pathways and etiology, as well as medical, psychological, and social sequelae of drug abuse- Proven, up-to-date methodologies for assessment- Challenges of gathering data from high-risk and other user populations- Sampling and application issues- Uses, sources, and limitations of treatment data- Analytical papers applying the methodologies to specific and global studies - The role of epidemiology studies in developing prevention strategies With this multifaceted approach to the subject, Epidemiology of Drug Abuse provides researchers and educators with a reference that sheds significant light on infrequently covered areas. In addition, its breadth and accessibility of coverage make it a teaching text suitable to courses in epidemiology, public health, and drug abuse."

A central task in a study of occasional, moderate, and stable nonmedical drug use was to distinguish such "controlled" use from destructive using patterns. A search of the literature revealed the lack of objective and precise definitions of drug abuse and the extent to which this had hampered efforts at treatment, prevention, and research. Popular conceptions of abuse ignored the variability of drug-using styles and tended to reflect the social acceptability of various drugs and Puritanical values. Purportedly scientific definitions, including those of the World Health Organization, proved vague, inconsistent, and culturally biased. Users' self-evaluation of their drug-taking and quantitative measures also proved inadequate. Given these difficulties, we conclude that "drug abuse" and similar terms should be replaced by more accurate descriptions of the actual drug-using situation and, if possible, illustrated with case material.

Intro -- Contents -- Abbreviations -- 1: Introduction -- References -- 2: Neurobiological Basis of Drug Abuse -- References -- 3: Neuroimaging Studies in Drug Abusers -- References -- 4: Basic Substance Characteristics and Neuropathological Findings in Drug Abusers -- 4.1 Cannabis -- 4.1.1 CNS Complications -- 4.1.2 Cannabis Psychosis and Schizophrenia -- 4.2 Opioids -- 4.2.1 Neuropathological Findings -- 4.2.2 Alterations of Neurotransmitters, Receptors, and Second Messengers -- 4.3 Cocaine -- 4.3.1 Cerebrovascular Complications -- 4.3.2 Alterations of Neurotransmitters, Receptors, and Gene Expression -- 4.4 Amphetamines, Methamphetamine, and Related Synthetic Substances -- 4.4.1 Cerebrovascular Complications -- 4.4.2 Neurotoxicity -- 4.4.3 Amphetamine and Methamphetamine Derivatives -- 4.4.3.1 MDMA -- 4.4.3.2 Neurotoxicity of MDMA -- 4.5 Designer Drugs and New Psychoactive Substances -- 4.5.1 Synthetic Opioids -- 4.5.2 Synthetic Cannabinoid Receptor Agonists -- 4.5.3 Psychostimulant NPS -- 4.5.4 Hallucinogenic NPS -- 4.5.5 Dissociative Substances -- 4.5.6 Sedative/Hypnotics Benzodiazepine Analogs -- 4.6 Polydrug Abuse -- References -- 5: Neuropathological Findings in Drug Abusers -- 5.1 Neurons -- 5.2 Microglia -- 5.3 Astrocytes -- 5.4 White Matter -- 5.5 Blood-Brain Barrier (BBB) -- 5.6 Cerebrovascular Alterations -- References -- 6: Neurotoxicity and Neurodegeneration of Drug Abuse -- References -- 7: Summary and Implications for Research.

The stereotypic view of the drug addict as a ne'erdo-well who cannot cope with the real world is challenged and a "career" model explicated. The similarities of drug careers to professional careers, particularly those of physicians, are noted. The analysis also delineates the developmental stages of the drug career: initiation, escalation, maintenance, discontinuation and renewal. More positive approaches to the prevention of substance abuse are recommended.