Norman S. Miller

Cocaine-associated violence and relationship to route of administration

The relationship between route of cocaine administration, that is, free base/crack smoking (FB), intravenous injection (IV), and nasal insufflation (NS) and level of violence was studied. The authors hypothesized that the route that produced the most intense effects (i.e., FB > IV > NS) would produce the highest level of violence. Over a 12-month period, 194 cocaine users were screened. After excluding polydrug users, 101 patients of both sexes participated in this study for the evaluation of expressions of violence. Evaluations were conducted by a structured questionnaire. The order of level of increased violence matched that of the most intense route of administration for some measures only. FB and IV use generally produced the same level of violence for most measurements. Both FB and IV routes produced more violence than NS. Violent actions requiring sustained activity (e.g., rape, burglary, and armed robbery) showed no relationship to route. The difference in levels in violence between males and females varied according to circumstance, not route of administration.

Treatment of khat addiction

The authors present two cases of khat addiction that were successfully treated with bromocriptine. Khat is a bush cultivated in the Mid East because of its highly stimulant effects. Its leaves contain a variety of sympathomimetics. While khat is rarely found in the U.S., American soldiers stationed in the Arabian peninsula may be exposed to it. Because of an alcohol interdiction during the current Persian Gulf crisis, these troops may be tempted to use this plant as an alternative recreational drug.

Fetal Effects of Maternal Alcohol Use

It has been generally accepted that alcohol in heavy doses produces birth defects. In July 1981, the Surgeon General of the United States issued an advisory on drinking during pregnancy: “Each patient should be told about the risk of alcohol consumption during pregnancy, and advised not to drink alcoholic beverages and to be aware of the alcoholic contents of foods and drugs.”1,2, 21, 22, 28

Suggestions for Changes in DSM-III-R Criteria for Substance Use Disorders

The revisions for the diagnosis of Substance Use Disorders in DSM-III-R provide significant improvements toward a more valid and reliable categorization of substance use disorders. However, additional considerations may be indicated to further enhance the utility of the DSM-III-R as a diagnostic instrument.

A Study of Violent Behaviors Associated with Cocaine Use: Theoretical and Pharmacological Implications

AbstractViolent behavior associated with cocaine use are characterized in this study. The types of violent behavior ranged from minor psychological aggressions to major physical acts that included murder. Aspects of such violent behavior associated with cocaine use were studied. During 1 month, 452 males who made inquiries for themselves or others to obtain information about the effects, diagnosis, and treatment of cocaine dependence were interviewed in phone conversations.

Treating Steroid Abuse: A Psychiatric Perspective

Youngstown, Ohio 44504. Anabolic-androgen steroids (AAS) are indicated medically for specific conditions, particularly androgen deficiency. However, because of their apparent capacity to improve physical and psychological performance, young athletes have been using AAS to increase competitiveness and self-image. AAS act on skeletal muscle to increase nitrogen retention and protein synthesis, thus increasing muscle size and strength. Aggressivity, euphoria and diminished fatigue are produced by effects on central nervous system androgen receptors. Psychiatric effects include depression, hyperaggressivity, mania and psychosis. Physical problems include cardiovascular abnormalities, hypertension, and tumor formation. Women report anovulation and virilization.

Drug Misuse in Alcoholics

Concurrent drug misuse is an increasing trend among alcoholics. It is occurring in an age-dependent manner so that the younger the age, the higher the incidence of concurrent misuse. Drugs concurrently misused by alcoholics, in decreasing order of frequency, are marijuana, cocaine and other sympathomimetics, phencyclidine, benzodiazepines, barbiturates, and psychedelics. Because of increasing prevalence of concurrent misuse, evaluation for alcohol detoxification should always include consideration of other drugs. Concurrent alcohol/drug addiction in alcoholics as well as increased incidence in alcoholism in families of drug addicts suggest a common genetic vulnerability to alcoholism and drug addiction.

The neurological legacy of psychoanalysis: Freud as a neurologist

The discipline of psychoanalysis was significantly influenced by Freuds experience in neuroanatomy and clinical neurology. Sigmund Freud began his medical career as a neuroanatomist and neurologist before he later established the theories and techniques of psychoanalysis. Freud made several significant contributions to research in neuroanatomy and clinical neurology that were overshadowed by his later accomplishments. As the Father of Psychoanalysis, Freud was, and his legacy always will be, that of a neurologist.

Prevalence and Pattern of Use

Alcoholism is much more common than most people, including physicians, think. Most people are reluctant to consider that alcoholism is a common disorder because of the peculiar stigma that is attached to it and the tenacious denial attendant to those who have alcoholism and those who do not. Also, the tendency to assign alcoholism to another disorder makes the alcoholism disappear in definitions only to reappear in an atypical or perplexing diagnosis. The medical profession and the public are reluctant to accept that drinking alcohol carries with it significant risk to develop a degree of loss of control over its use. Loss of control leads to myriad adverse consequences that are stereotypical and predictable for alcoholism which make it possible for alcoholism to be diagnosed.

Introduction and History

Alcoholism is less accepted as a disease than mental illness by the general public and the medical community. Various forms of mental illness are now considered true diseases; schizophrenia and manic-depressive illnesses are currently diagnosed and treated as disorders whose roots are from biochemical origins in the brain. The evidence for this contention is derived from animal research and response to pharmacological agents in these disorders.1