Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources.

The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse.

Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children.

Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care.

The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevance--to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

Contents

• COMMITTEE ON OPPORTUNITIES IN DRUG ABUSE RESEARCH
• Preface
• Acknowledgments
• Executive Summary
• 1. Introduction
  • MAJOR ACHIEVEMENTS IN DRUG ABUSE RESEARCH
  • VOCABULARY OF DRUG ABUSE
  • DEFINITIONS AND BASIC CONCEPTS
  • IMPORTANCE OF DRUG ABUSE RESEARCH
  • THE CONTEXT OF DRUG ABUSE RESEARCH
  • INVESTING WISELY IN DRUG ABUSE RESEARCH
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Behavioral Research
  • BEHAVIORAL MODELS
  • ACCOMPLISHMENTS
  • RESEARCH OPPORTUNITIES
  • CONCLUSION AND RECOMMENDATION
  • REFERENCES
• 3. Neuroscience
  • NEUROTRANSMISSION AND ITS EFFECTS
  • ACCOMPLISHMENTS
  • GAPS AND NEEDS
  • RESEARCH OPPORTUNITIES
  • CONCLUSION AND RECOMMENDATION
  • REFERENCES
• 4. Epidemiology
  • DEFINITIONS
  • ACCOMPLISHMENTS
  • RESEARCH OPPORTUNITIES
  • CONCLUSION AND RECOMMENDATION
  • REFERENCES
• 5. Etiology
  • ACCOMPLISHMENTS
  • RESEARCH OPPORTUNITIES
  • REFERENCES
• 6. Prevention
  • ACCOMPLISHMENTS
  • GAPS AND NEEDS
  • RESEARCH OPPORTUNITIES
  • REFERENCES
• 7. Consequences
  • HIV/AIDS
  • IMPACTS ON FETAL, INFANT, AND CHILD DEVELOPMENT
  • DRUG ABUSE AND VIOLENCE
  • REFERENCES
• 8. Treatment
  • OVERVIEW OF DRUG ABUSE TREATMENT
  • ACCOMPLISHMENTS
  • RESEARCH OPPORTUNITIES
  • HIV/AIDS
  • RECOMMENDATION
  • REFERENCES
• 9. Managed Care
  • OVERVIEW
  • ACCOMPLISHMENTS AND RESEARCH OPPORTUNITIES
  • BARRIERS TO RESEARCH
  • CONCLUSION
  • REFERENCES
• 10. Drug Control
  • RECURRENT ISSUES IN DRUG ABUSE CONTROL
  • EFFECTS OF REGULATION ON LEGITIMATE MEDICAL USE AND SCIENTIFIC RESEARCH
  • EFFECTS OF SUPPLY REDUCTION ON CONSUMPTION
  • EFFECTS OF CRIMINAL SANCTIONS ON DRUG USE
  • CONFIDENTIALITY AND FEAR OF PUNISHMENT
  • CONCLUSION AND RECOMMENDATION
  • REFERENCES
• Appendixes
  • A Acknowledgments
  • B Drug Abuse Research in Historical Perspective
  • C Diagnostic Criteria

Support for this study was provided by the National Institute on Drug Abuse (contract no. N01 DA-3-8000).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.