J. Thomas Ungerleider

Mental Health and Homelessness

This chapter presents the clinician’s view of homelessness and related mental health issues based on the experiences of a mental health outreach team (the “team”), which operates in the shelters, the meal programs, and the jail of a high-density homeless area in a coastal suburb of Los Angeles County. The beach cities of Santa Monica and Venice differ from downtown Los Angeles’s skid row, New York’s Harlem, and Boston’s “combat zone” in that they are largely residential areas, are easily accessible by bus from downtown, border on the Pacific Ocean, and contain many public parks.1 Violence is less than in downtown skid row, but there are fewer shelters and social service facilities.

Interactive teaching, medical students, and substance abuse university and community come together in a new endeavor

The authors present an innovative approach for providing freshman and sophomore medical students with their initial exposure to the problems of alcohol and other drug abuse. Students in small interactive group seminars teach each other about the major areas of substance abuse: treatment, prevention/education, research, and law enforcement. They are aided by group moderators, by resource professionals, and by recovery teachers as they make field trips, attend 12-step meetings, and get background material. They utilize audiovisuals, role-plays, and programmed patients in a report/debate format. Effects of this seminar on their attitudes have been measured and are presented.

Changes in the Drug Scene: Drug Use Trends and Behavioral Patterns

The “drug scene” in the United States has evolved very dramatically in the period from prior to 1965 to the present. The sociology of drug use patterns was rather constant prior to 1965. In the mid 1960s “fashionable trends” in drug use took shape, starting with use of psychedelics for consciousness expansion. This led to poly-drug use, where the quality of the drugs taken deteriorated leading to present availability of “look alikes” which are manufactured to resemble original drug products but are counterfeit controlled substances. Several special current drug problems currently exist including freebasing cocaine, phencyclidine use and methaqualone use. The potential behavioral meanings of drug use are discussed, which may be multiple and multi-determined in nature. The interface of adolescent development issues and family dynamics are important to consider in regard to potential underlying reasons for adolescent drug abuse.

THERAPEUTIC USES OF THE DRUGS OF ABUSE

Any discussion of the therapeutic uses of the drugs of abuse requires careful attention both to definitions and to terminology. First of all, by therapeutic, we are here referring to a drug which is used in “modern” medicine rather than in folk medicine, and a drug which demonstrates more than a placebo effect. Time constraints preclude consideration of the therapeutic uses of all the drugs of abuse and even of all psychoactive drugs, those which affect the mind and behavior. Therefore, we will discuss selected drugs of abuse, particularly those drugs about which some controversy currently exists. We will make our selection from among those drugs which are in the Controlled Substances Act (C.S.A.), particularly in Schedule 1. The Controlled Substances Act of 1970, a Federal act which has been adopted by many states, imposes nine kinds of controls on scheduled or abusable substances. These drugs are here divided into five schedules according to the dual criteria of abuse potential and therapeutic usefulness. Severity of penalties for drug related offenses is partially related to these schedules. Those drugs which are in Schedule 1 have, by definition, a high drug abuse potential, are unsafe even when given under medical supervision, and have no therapeutic usefulness. We will attempt to discuss only briefly policy and political issues, placing emphasis o n scientific concerns. Thus, three of the four drugs selected for discussion are from Schedule 1 . They include: LSD, marijuana, and heroin. Heroin has been covered in the previous presentation and so the material we will present about it will be somewhat abbreviated. We will also include, from Schedule 2, the amphetamines, currently the center of heated controversy in this country as far as the legal regulation of the indications for which they may be prescribed.

Marijuana for the oncology patient.

Loss of appetite, nausea, and vomiting are among the most common adverse and unpleasant side effects of chemotherapy. Delta-9-tetrahydrocannabinol (THC), one of the most psychoactive ingredients in marijuana, has been shown to relieve these symptoms (1,2). Anecdotal accounts, folklore, ancient history, and contemporary clinical research suggest that marijuana may hold potential for medicinal use. Until the 1930s tincture of

Bias and the Cannabis Researcher

Abstract: This report focuses on several aspects of the “drug” cannabis in our society: the historical notion of a chemical as a moral issue (i.e., good and evil) rather than a pharmacological one; the scientist as a human being as well as a witting or unwitting influencer of social policy; the statistical design and manipulation of research consciously or unconsciously for fame and fortune (grants); the research treatment “connection” as part of our drug abuse industrial complex, a billion dollar a year industry; and the covert governmental manipulation and distortion of cannabis (and other drug) data.

Drug Abuse: Crisis in the Treatment Arena

This paper provides a perspective of the current crisis in drug abuse programming and an analysis of some of the contradictions, paradoxes, and problems which underlie this crisis. Precipitating factors in the development of the crisis are discussed, as are their components. These include lack of definition of success, duplication and overlapping of efforts and funding (stressing the matrix concept and revenue sharing), little cost-effectiveness, inadequate training of treators, a peculiar treatment and criminal justice “merger,” improper drug “scheduling,” and misleading drug terminology. Serious consideration of the issues which have been presented here is most critical.