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Physicaal nd Mental Effects
of PsychoactivDe rugs
EighthE dition
Darryl S. Inaba, Pharm.D., CATC-VC, ADC Ill
Director of Clinical and BehavioralH ealth Services,A ddictions Recovery
Center, Medford, Oregon
Director of Research and Education,C NS Productions,I nc., Medford, Oregon
AssociateC linical Professor of Pharmacology,U niversityo f California
Medical Center, San Francisco
Consultant/Instructor, Universityo f Utah, School on Alcoholism and
Other Drug Dependencies,S atl Lake City, Utah
William E. Cohen, CGACI
CNS Productions, Inc.™
Medford, Oregon
CNS Productions, Inc.™
Publisher: Paul J. Steinbroner
11 Almond Street
Medford, OR 97504
Tel: (800) 888-0617 · Fax: (541) 773-5905
Web Site: www.cnsproductions .com
E-mail: [email protected]
Uppers, Downers, All Arounders, Eighth Edition
© 2014 Darryl S. Inaba
First Edition ©1989
Second Edition ©1993
Third Edition ©1997
Fourth Edition ©2000
Fifth Edition ©2004
Sixth Edition ©2007
Seventh Edition ©2011
Editors: Ellen Cholewa and Elizabeth van Radics
Book Design and Illustrations: Impact Publications/David Ruppe, Medford, Oregon
Cover Design: Don Thomas Illustration , Ashland, Oregon
Printing and Color Separations: Cedar Graphics , Cedar Rapids, Iowa
Co-writer, Chapter 10: Pablo Stewart , M.O., Clinical Professor of Psychiatry,
University of California, San Francisco, School of Medicine
Special thanks to:
Addictions Recovery Center , Medford, Oregon
Hassan Igram, Founder, Cedar Graphics, Cedar Rapids, Iowa
Disclaimer: The information in this book is in no way meant to replace
professional medical advice or professional counseling and treatment.
Publisher's Cataloging-in-Publication
Inaba, Darryl S.
Uppers, downers, all arounders: physical and mental
effects of psychoactive drugs/Darryl S. Inaba, William E. Cohen-8th ed.
p.cm.
Includes index
LCCN: 2014938512
ISBN: 978-0-926544-39-0
Psychoactive drugs-- Side effects. 2. Drug abuse-
Complications. I. Cohen, William E., 1941-ll. Title
All rights reserved. No part of this book may be reproduced or utilized in any form, electronic
or mechanical , including photocopying, recording, storing in any information and retrieval system,
or transmitting by any means without prior written permission of the publisher.
Printed in the United States of America
Uppers, Downers, All Arounders, Eighth Edition, is adoringly dedicated
to the creative genius of its co-author, William E. Cohen. Bill was
already established as a national Peabody- and Emmy Award-winning
video journalist when he teamed up with co-author Dr. Darryl Inaba
and producer Paul Steinbroner in the 1970s to create the educational
film Psychoactive. Like most professionals who are exposed to the
addiction field, Bill became immediately enchanted by the courageous
struggle and the miraculous recovery outcomes of those vulnerable
to the medical condition now known as substance-related and
addictive disorders. Most of all, Bill became fascinated by the evolving
science of addiction and recovery. He immediately went from that
first film to create the educational booklet by the same name, which
was the forerunner of this publication, now in its eighth edition. Bill
also became a Certified Gambling Addiction Counselor ( CGAC I) and
assisted several hundred individua ls struggling with this condition
into recovery many decades before gambling was finally recognized
as an addiction by the DSM-5, published in May 2013. As clinicians
and educators fall in love with this field, William E. Cohen fell in love
with Uppers, Downers, All Arounders and dedicated his entire life to
promoting a better understanding of addiction and recovery
William E. Cohen
November 2, 1941-May 20, 2014
•
Key Phrase Highlights Key phrases are in boldface throughout the book
to emphasize the most significant concepts and to help the reader prioritize
the information . Chapter introductions and reviews, exercises, and most test
questions are based on these boldfaced phrases.
Study Guide and Glossary A study guide and glossary are available for
download from our Web site. More information can be found on the inside
front cover of this book.
Supplementary Material Visit www.cnsproductions.com for additional
content. Dr. lnaba's weekly podcast, video blogs, a reader forum, useful links,
and other learning tools are regularly updated and available 24/7. You can
access a video clip specific to each chapter using the QR (quick reference)
tags found on each chapter's opening page.
Data and References Every effort has been made to incorporate the most
current and comprehensive information available at the time of publication .
Some of the research studies cited are conducted every 2, 5, 10, or in some
cases 20 years and are included to illustrate trends or because they provide
pertinent information that is not time sensitive. References are cited after
significant data presentations by numerical position in each chapter. These
are then available for download from our Web site by chapter where the
reference was cited.
Note: The registered trademark symbol ® distinguishes trade (brand) names
of prescription and over-the-counter drugs from chemical (generic) names.
Chapter 1
PsychoactiveD rugs: Uppers
dassificationandHistory Introduction
C..nl!falClassification
::fi";':~~ ionofPsyd,oactiveDrugs
General Effects
),fajorDrug< Cocaine
OtherDrug,andAddictions Smok>bl,Cocaine(crack .f=ba«,oxidado)
Amphetamines
~:i:c:o ~oactiv,, Drugs
t:t;.1~:i:~ ~!:'.:counter Stimulants
Fh,eHi>toricalTh<meso/DrugU«
Miscelbneou,PbntStimubnts
Prd>i>toryrndtheNrolithicPeriod
(8300-i OOOB.C) uff<ine
AncientCiviliz.:otion,(4000B.C. -A.D.100)
TheMiddleAg<>(-400 -1100)
TheR,nal,..nceandtheAgeofDi,;cov,ry ChapterReview
(1+00- 1700)
TheAgeofEnlight<nmentandtheUriy
Chapter 4
lndu,;lrullR<volution(l700-1900)
TheTwenti<thUiltury
Downers:O piates/Opioids
~::;;:,,";;,!omorrow
and Sedative-Hypnotics
Chapte<Review C..nl!falClassification -t.l
MajorO.pre,.,,mts i .l
MinorD<pT<Ssana
Chapter 2
Prescription Drug Epidem ic
TheNeurochemistryand
~~i::~ ~o id,
the Physiologyo f Addiction
Cbmfication i.6
HowP!;yd,oactiv,,DrugsAffectl'eople Hi>toryofMethodsoll'« i.7
HowDrug,G<ttoth<Br>.in Twmti<th andTwmty-Fir>tCenturie,
The Nervous System Effect>ofOpioid,
Neuroanatomy Thaap,uticPainControlv. .Hyp,ralgesia
Phy,iological R«pons«toDrug> Additiona!Complicatioru;C.us«lbyOpioid.s
FromExp,rimentationtoAddiction
~~ru1~:"::1ai:;E~~! didion
Sp,cificOpioids
Theorie,ofAddiction Sedative-Hypnotics
Her<dity.Env!ronment,P,ychoactiveDrug,
~:l:cation
~io~~~:;~~"' •~~";'Mice
~!:~\~:!
View of th< Addictive Proc<SS
Chapte<Review Oth<rSroativ<-Hypnotic, i .il
Druglnt<r.tctiom i .+4
PrescriptionDrug,andth<Phnmocrnticallndu,;tryi .+4
ChapterReview
•
Chapter5 Anticholinergic Psychedelics
5.0
(belladonna , henbane, mandrake, and
datura (jimsonweed, thomapple]) 6.20
Downers: Alcohol
PCP, Ketamine, Salvia Divinorum, and
Overview 5.1 Other Psychedelics 6.21
Introduction 5.1 Marijuana and Other Cannabinoids 6.25
History 5.2
Chapter Review 6.46
AlcoholicB everages 5.5
The Chemistry of Alcohol 5.5
Chapter7
Types of Alcoholic Beverages 5.5 7.0
Absorption,D istribution,a nd Metabolism 5.8
Other Drugs,O ther Addictions
Absorption and Distribution 5.8
Metabolism 5.9 Introduction 7.1
Desired Effects,S ide Effects, Other Drugs 7.2
and Health Consequences 5.10 Inhalants 7.2
Levels of Use 5.11 Sports and Drugs 7.11
Low-to-Moderate-Dose Episodes 5.12 Miscellaneous Drugs 7.27
High-Dose Episodes 5.14
Other Addictions 7.30
Chronic High-Dose Use 5.17
Compulsive Behaviors 7.30
Addiction Heredity, Environment , and Compulsive Behaviors 7.31
(alcohol dependence,o r alcoholism) 5.21 Compulsive Gambling 7.33
Classification 5.21 Compulsive Shopping and Buying 7.43
Heredity, Environment, and Psychoactive Drugs 5.23 Hoarding 7.44
Tolerance, Tissue Dependence, and Withdrawal 5.24 Eating Disorders 7.45
Directions in Research 5.26 Sexual Addiction 7.55
Other Problemsw ith Alcohol 5.27 Electronic Addictions 7.57
Polydrug Abuse 5.27 Conclusions 7.61
Alcohol and Mental Problems 5.27 Chapter Review 7.62
Alcohol and Pregnancy 5.28
Aggression and Violence 5.31
Chapter8
Driving Under the Influence 5.33 8.0
Injuries and Suicide 5.35
Epidemiology 5.35 Drug Use and Prevention:
Patterns of Alcohol Consumption 5.35 From Cradle to Grave
Population Subgroups 5.37
Prevention 8.1
Ethnic Populations 5.42
Concepts of Prevention 8.2
Conclusions 5.44
History 8.3
Chapter Review 5.45 Prevention Methods 8.7
Challenges to Prevention 8.15
Chapter6
6.0 From Cradlet o Grave 8.17
Patterns of Use 8.17
All Arounders Pregnancy and Birth 8.18
Youth and School 8.27
Introductiona nd History 6.1
Love, Sex, and Drugs 8.34
Classification 6.3
Drugs at Work 8.46
General Effects 6.3 Drugs in the Military 8.49
LSD, Psilocybin Mushrooms, and Other Drug Testing 8.50
Indole Psychedelics 6.5 Drugs and the Elderly 8.54
Peyote, MOMA, and Other Phenylalkylamine Conclusions 8.58
Psychedelics 6.13 Chapter Review 8.59
Chapter 9 TargetP opulations 9.54
9.0
Men vs. Women 9.54
Youth 9.54
Treatment
Older Americans 9.55
Introduction 9.1 Ethnic Groups 9.57
A Disease of the Brain 9.2 Other Groups 9.61
Current Issues in Treatment 9.2
TreatmentO bstacles 9.62
TreatmentE ffectiveness 9.6 Developmental Arrest and Cognitive Impairments 9.62
Treatment Studies 9.6 Follow-Through (monitoring) 9.63
Drug Abuse Treatment Outcome Study 9.6 Conflicting Goals 9.63
Treatment and Prisons 9.7 Treatment Resources 9.64
Principlesa nd Goalso f Treatment 9.8 Medical InterventionD evelopments 9.64
Principles of Effective Treatment 9.8 Introduction 9.64
Principles of Drug-Abuse Treatment Medications Approved to Treat SUDs
for CJS Populations 9.8 vs. Those Used Off-Label 9.64
Goals of Effective Treatment 9.9 Medical Strategies in Development to Treat SUDs 9.66
Selectiono f a Program 9.10 The New Drug Development Process 9.68
Diagnosis 9.10 ChapterR eview 9.69
Treatment Options 9.12
BeginningT reatment 9.14
Chapter 10
10.0
Recognition and Acceptance 9.15
TreatmentC ontinuum 9.18
Mental Health and Drugs
Detoxification 9.19
Initial Abstinence 9.20 Introduction 10.1
Long-Term Abstinence 9.20 Determining Factors 10.3
Recovery 9.21 Dual Diagnosis( co-occurringd isorders) 10.5
Relapse Prevention 9.21 Definition 10.5
Relapse Prevention Strategies 9.24 Epidemiology 10.6
Outcome and Follow-Up 9.24 Patterns of Dual Diagnosis 10.7
Individualv s. GroupT herapy 9.25 Making the Diagnosis 10.7
Individual Therapy 9.25 Mental Health vs. Substance Abuse 10.9
Group Therapy 9.26 Psychiatric Disorders: Pre-Existing
Treatmenta nd the Family 9.31 Mental Disorders 10.13
Substance-Induced Mental Disorders 10.18
Goals of Family Treatment 9.32
Different Family Approaches 9.32 Treatment 10.21
Other Behaviors 9.33 Psychopharmacology 10.24
Trauma-Informeda nd Trauma-FocusedC are 9.34 ChapterR eview 10.31
RecoveryC oach 9.34
Adjunctivea nd Complementary References R.1
TreatmentS ervices 9.35
Glossary G.1
Drug-SpecificT reatment 9.37
Index 1.1
Polydrug Abuse 9.37
Stimulants (cocaine and amphetamines) 9.37
Tobacco 9.39
Opioids 9.41
Sedative-Hypnotics (barbiturates and
benzodiazepines) 9.43
Alcohol 9.44
Psychedelics 9.46
Marijuana 9.46
Inhalants 9.48
Behavioral Addiction Treatment 9.48
