Current Drug Abuse Reviews - Volume 3, Issue 1, 2010

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Research has revealed inconsistencies regarding the relationship between social anxiety and alcohol use. The goal of the current review is to examine lab-based studies that have been conducted in an attempt to help disentangle the social anxiety - alcohol link. Specifically, this review focuses on the most prominent theories present in this area of research, namely, the Tension Reduction Theory, the Stress-Response Dampening Model, the Self-Awareness Model, the Attention Allocation Model, and the Appraisal-Disruption Model. The review then describes the empirical studies that have been conducted to test predictions derived from each of these theories. This is followed by a discussion of some methodological considerations in this area of research, including an examination of participant characteristics, study selection criteria, alcohol administration procedures, the nature of the anxiety-inducing tasks that have been used in this area of research, and the different types of outcome measures that are typically used to measure social anxiety. The review ends with some tentative conclusions and directions for future research, including recommendations to recruit individuals with high levels of trait social anxiety, to closely monitor blood alcohol levels achieved at different time points during the study, to examine more interaction-based social anxiety provoking tasks, and to employ a wider range of outcome measures (e.g., cognitive and behavioural outcomes relevant to social anxiety).

Roadside studies indicate that 1-15 % of drivers drive under the influence of one or more drugs of abuse. After drug use, drivers are more often culpable for an accident than non-users. Information on drugs and traffic safety comes from roadside studies, epidemiological research, experimental studies on driving-related skills, and on-the-road driving tests. Roadside studies show that drivers most frequently test positive for the use of alcohol and/or cannabis. These two drugs affect driving ability in a dose-dependent matter and result in poor vehicle control, especially when used in combination. Drivers on cocaine, ecstasy and amphetamine show no impairment on basic driving skills, but often overestimate their driving skills. In combination with impaired decision making, this increases risk taking during driving. Only few studies looked at the effects on driving of other drugs of abuse, such as ketamine, inhalants and anabolic steroids, but suggest a negative effect on driving performance. In conclusion, most drugs of abuse negatively affect driving ability, especially when used in combination with alcohol or another drug. It is of concern that a substantial number of drug users are not aware that their driving is impaired.

Carisoprodol (N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; N-isopropylmeprobamate) is a centrally acting skeletal muscle relaxant whose primary active metabolite is meprobamate, a substance with well established abuse potential similar to that of benzodiazepines. A number of reports show that carisoprodol has been abused for its sedative and relaxant effects, to augment or alter the effects of other drugs, and by the intentional combination of carisoprodol and other noncontrolled medications because of the relative ease (as compared to controlled substances) of obtaining prescriptions. The diversion and abuse of carisoprodol and its adverse health effects appear to have dramatically increased over the last several years. Clinicians have begun to see a withdrawal syndrome consisting of insomnia, vomiting, tremors, muscle twitching, anxiety, and ataxia in patients who abruptly cease intake of large doses of carisoprodol. Hallucinations and delusions may also occur. The withdrawal symptoms are very similar to those previously described for meprobamate withdrawal, suggesting that what may actually be occurring is withdrawal from meprobamate accumulated as a result of intake of excessive amounts of carisoprodol. However carisoprodol itself is capable of modulating GABAA function, and this may contribute both to the drugs abuse potential and to the occurrence of a withdrawal syndrome with abrupt cessation of intake. Carisoprodol has been classified as a controlled substance in several states in the US and restrictions on the use of the drug have been imposed in some European countries. Carisoprodol is metabolized to a controlled substance, has clear evidence of abuse potential and increasing incidence of abuse, and has shown evidence of a withdrawal syndrome with abrupt cessation from intake. This article will discuss the abuse potential of carisoprodol and the associated withdrawal syndrome, and consider implications for future use of the drug.

Epidemiological studies demonstrate that excessive drinking is associated with hypertension, cerebral bleeding and loss of cardiac contractility. Conversely, studies have shown that mortality rates for people who regularly drink ethanol in moderation are lower than in abstainers, primarily due to decreased fatal ischemic heart disease. Further, moderate ethanol consumers have lower rates of myocardial infarction compared with abstainers. These beneficial cardiac effects may be due to pleiotropic effects of ethanol on lipids, platelets, and fibrinolytic activity. During the past decade, studies conducted in several animal models have revealed that light to moderate regular ethanol consumption renders hearts more tolerant to myocardial ischemia-reperfusion injury; to a degree similar to cardiac ischemic preconditioning (brief episodes of ischemia dramatically limit infarct size following prolonged ischemia). Recent clinical evidence suggests that light to moderate ethanol consumption in the year prior to myocardial infarction is associated with reduced mortality following myocardial infarction. These findings suggest that light to moderate ethanol consumption not only prevents myocardial infarction but also improves survival after myocardial infarction. Proposed mechanisms of cardioprotection by regular ethanol consumption include activation of adenosine A1 receptors, α1-adrenoceptors, protein kinase C-δ and ε, adenosine triphosphate-dependent potassium (KATP) channels, nitric oxide synthase and reduced leukocyte-endothelial cell adhesive interactions. In this review, we focus on the recent progress in elucidating the endogenous myocyte signaling mediating cardioprotection by light to moderate ethanol consumption.

Cocaine dependence is a complicated, destructive, and often chronic illness that is difficult to treat. In this article we review the challenges in treating cocaine dependence, as well as recent developments and future directions in psychosocial and pharmacological treatment relevant to treatment of cocaine dependence. Cocaine is one of the most addictive drugs because of its immediate and powerful rewarding effects. Often, cocaine dependent individuals experience difficulty abstaining due to cognitive impairments from repeated cocaine use, strong use-related social and environmental cues, and high levels of life stress. Cocaine use also affects areas of the brain related to motor function, learning, emotion, and memory, further complicating the administration of effective interventions. In addition, development of treatments for cocaine dependence has been complicated by the tendency for abusers not to complete treatment programs and their propensity for relapse. Despite these challenges, some treatment approaches, such as cognitive behavioral therapy (CBT) and medications have shown promise in successfully treating cocaine dependence. However, individually, each of these treatments exhibit weakness in longitudinal studies where long-term abstinence is the primary outcome of interest. Although other treatments are being explored, thus far, the combination of CBT and pharmacotherapy has elicited the best results for treating cocaine dependence with respect to patient retention and relapse prevention following abstinence. No treatment method has yet been shown to completely and effectively treat cocaine dependence. More research is necessary to test treatment programs and garner further information in order to better understand and treat cocaine dependence.

The desire to feel good is an important motivation for human behavior. Happy people have better health perspectives, live longer, and report a higher quality of life. Although happiness can be established in a healthy way, people are also easily tempted by unhealthy pleasures. CRAVING FOR ECSTASY AND NATURAL HIGHS: A POSITIVE APPROACH TO MOOD ALTERATION by Harvey B. Milkman and Stanley G. Sunderwirth is an outstanding book on the universal desire to feel good, and ways to manage this desire. It describes the biological, psychological and social pathways to pleasure, but also the risk of dependence and addiction that may be the outcome of these unhealthy behaviors. Besides the more usual forms of addiction to alcohol and drugs of abuse, the authors also describe other addictive behaviors such as those related to eating behavior, sex, gambling, and the internet. The authors' approach to mood alteration is indeed a positive one: achieving happiness throughout the lifespan is very important, but we should aim at “natural highs”, seeking healthy means for feeling good. In a balanced way, Milkman and Sunderwirth answer a variety of questions such as “Should I try ecstasy?” or “Does dieting work?” As opposed to most books on addiction, the authors offer a range of alternatives for unhealthy behaviors. Readers will gain insight in addictive behaviors of themselves and others who may have lost control in their pursuit of pleasure. The book ends with a Personal Pleasure Inventory that can be completed by readers who wish to become more mindful of the activities and experiences that are likely to promote their natural highs.