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 relevanceâ€"to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

Symposium presentations address: molecular biological tools in exploring behavior; drugs of abuse and the immune system; marijuana use; motivational aspects of drug abuse; excitatory amino acids in stimulant abuse and AIDS dementia; agonist efficacy, drug dependence, and medications development; drugs of abuse and gender differences; presynaptic and postsynaptic neurochemical alterations in human psychostimulant abusers; antibody and protein based therapies for drug abuse; behavioral and pharmacological interventions for pregnant substance abusers; and mechanisms of abused drugs: concordance between lab. animal and human studies.

This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

Abuse of drugs and alcohol may cause serious difficulties at work including deterioration in job performance. Abuse is caused by a range of personal, family, social or work situations or a combination of such factors. This report presents a variety of multidisciplinary approaches to the prevention, assistance, treatment and rehabilitation of alcohol- and drug-related problems in the workplace. Although experience has shown the difficulty of eliminating substance abuse, the policies presented are likely to yield constructive results for workers and employers alike.