Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
COMBINATIONS OF DRUGS Individuals combine drugs for various reasons. Common rea- sons include synergistically increasing the effects of the drugs and using one drug to offset the side effects of another drug. Common combinations of drugs include heroin and cocaine (known as a “speedball”), cocaine and alcohol or marijuana, cocaine and PCP, methadone and alcohol or cocaine, and tranquilizers and alcohol. THEORIES OF ADDICTION Numerous theories of substance misuse and addictions exist, with each one having different implications for intervention and treatment. However, the etiology of AOD abuse and addiction still remains empirically unsubstantiated and debat- able. Several theories focus on a disease model of addiction, while others focus on environmental factors. The majority of addiction researchers believe that substance use disorders are a result of multiple factors, including but not limited to genetics; neurotransmitters; and environmental, behavioral, and cultural factors (Straussner, 2014). Therefore, clinicians are advised to use a multifactorial perspective when working with individuals who have problems with AOD abuse and addiction. The following sections present some of the most common theories, categorized by their relevant factors. BIOCHEMICAL AND GENETIC FACTORS Decades of scientific research have identified the role played by genetics in predisposing individuals to substance addiction. Studies using methodologies focused on the examination of twins, half-siblings, and adopted children of parents with alcohol use disorder (Gerra et al., 2019) have found a likely genetic predictor of alcohol use disorders, predominantly among males. Some studies have found that genetic factors are stronger predictors of early substance use initiation when compared with environmental factors, with genetics account- ing for 30% to 75% of the risk for addiction (National Center on Addiction and Substance Abuse at Columbia University [CASA Columbia], 2012; NIDA, 2021d). Several important findings have resulted from the examination of the role of genetics in addiction. First, an individual’s family history of addiction is associated with addiction regardless of socioeco- nomic status (Straussner, 2013). Second, there does not seem to be a single gene that predicts addiction. Instead, it is believed that an interaction of several genes and environmental factors increases an individual’s risk for addiction (Straussner, 2013). Finally, it is important to note that, in spite of the significant role of genetic impact on inheriting a SUD, other factors are at least half, if not more, influential (Gerra et al., 2019). Obviously, more research is needed to identify reliable genetic biomarkers of SUDs risk.
averaged 12.55%, while the THC content of marijuana con- centrates averaged 52% (DEA, 2014). The highly flammable butane gas that is used to extract THC from the marijuana leaf has caused explosions, injuries, and deaths. SYNTHETIC DESIGNER AND CLUB DRUGS Synthetic designer drugs are, as the name implies, synthesized in clandestine laboratories and resemble highly potent doses of marijuana, amphetamines, or narcotics in their effects. Since 2009, U.S. law enforcement officials have identified more than 240 new synthetic compounds. Most wholesale quantities of synthetic drugs are purchased over the Internet and are shipped from distributors in China (DEA, 2020). Synthetic cannabinoids, often marketed as synthetic marijuana under names such as “K2” and “Spice,” are a mixture of plant matter and synthetic chemicals. Spice is more potent, longer lasting, and more difficult to detect with common urinalysis drug testing than regular marijuana, which may explain its popularity. Users of synthetic cannabinoids may experience severe nausea and vomiting, agitation, anxiety, racing heart- beat and chest pain, high blood pressure, acute renal failure, intense hallucinations, psychotic episodes, suicidal ideation, and short-term cognitive impairments, as well as a potentially deadly overdose. The long-term effects of synthetic marijuana use are currently unknown (Kain, 2021; Lubarsky et al., 2014; NIDA, 2021j). Synthetic cathinones (an amphetamine-like stimulant found naturally in the khat plant), commonly sold as “bath salts,” are drugs that cause powerful reactions and even violent behavior. Like users of spice, some users of bath salts experience nau- sea, vomiting, paranoia, hallucinations, delusions, suicidal thoughts, seizures, chest pains, and increased blood pressure and heart rate. Synthetic cathinones have resulted in a number of deaths from overdose (NIDA, 2021i; DEA, 2020). There are also many drugs that mimic the characteristics of amphetamines or narcotics. These drugs include MPTP, China White, methylenedioxymethamphetamine (MDMA, Ecstasy), gamma-hydroxybutyrate (GHB, Grievous Bodily Harm, G, Liquid Ecstasy, Georgia Home Boy), flunitrazepam (Rohyp- nol, Roofies, Rophies, Roche, Forget-Me Pill), and ketamine (Special K, K, Vitamin K, Cat Valiums) (DEA, 2020). A com- mon and more potent substitute for MDMA is sold under the name of “Molly.” These drugs do not have a uniform chemical makeup because they differ based on manufacturer. Often these drugs contain contaminants, which have led to mental and physical health problems. Furthermore, drugs in this class (e.g., Rohypnol) tend to be colorless, tasteless, and odorless and are often used as a tactic to perpetrate sexual assault.
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