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The majority of people who experience incarceration have a history of harmful alcohol, tobacco, and/or illicit drug use. Some discontinue use of these substances while in custody. Others—notably including some people who inject drugs—continue to use drugs in prison, typically in avoidably high-risk circumstances. Rapid relapse to risky substance use after release from prison is common and is associated with a range of health and social problems, and increased risk of both death and reincarceration. Effective measures to reduce the incarceration of people who use drugs, and to minimize drug-related harms both in prison and after release from custody, are urgently required. However, the evidence base to inform effective responses remains weak, and implementation of evidence-based responses remains patchy. Drawing on the expertise of 40 authors from 10 countries, this book reviews what is known about the epidemiology of substance use in people who experience incarceration. It presents what is known about the health, social, and criminal justice consequences of harmful substance use in this population and discusses key policy reforms that have the potential to achieve better health outcomes. In addition to reviewing what is known, the book identifies key knowledge gaps and makes recommendations for future research.Less

This book addresses (1) candidate mechanisms across addictive behaviors, including impulsivity (Chapters 1–5); reward sensitivity (Chapter 2); behavioral sensitization and cross-sensitization to addictive, stressful, or endogenous illness-related stimuli (Chapters 1, 5–8, 13); and genetics (Chapter 11). Addictions frequently combine with other psychiatric disorders; each increases severity of the other (Chapters 1, 7, 13). Genetic or epigenetic mechanisms underlying addictive processes may overlap with those involved in predisposing illnesses (Chapters 5, 11, 13). Addressed are (2) resilience to addictions despite substance use (Chapters 1, 3–5, 7, 13); (3) clinical contexts of addictive behavior, including nicotine (Chapter 3, early onset), opiates (Chapter 4; resilience and impulsivity), alcohol (Chapter 5; stimulant-like effects), stimulants (Chapter 9), marijuana and cannabinoids (Chapter 10; endocannabinoid systems strategic role in motivation and reward), nonpharmacological addictions (Chapter 8; sexual addictions), and interactions between addictions and other recurrent/progressive brain diseases (Chapters 1, 13). Topics include (4) strategies for addiction prevention and treatment, including targets related to impulsivity (Chapters 1, 2, 4, 5), decision-making (Chapter 2), sensitization (Chapters 1, 13), and prevention (Chapters 5, 13); nonpharmacological treatments for impulsivity (Chapters 2, 4), decision-making (Chapter 2), and sensitization prevention (Chapter 13), pharmacogenetics (Chapter 11), and study design and analysis strategies that account for complex neurobehavioral interactions underlying addiction treatment (Chapter 12). Chapter 13 integrates addictive and other psychiatric diseases, especially regarding progression and sensitization, in a clinically oriented manner. Understanding the basic neurobehavioral mechanisms and sources of resilience against them will lead to more effective prevention, diagnosis, and treatment.Less

Prescription Drug Diversion and Pain provides an interdisciplinary overview of medications used to treat chronic pain, and the benefits and risks that are posed by long-term use of opioids. Use of these life-saving medications must be carefully managed to prevent serious side effects, which may include physical dependence, addiction, and even death. In recent years, the risk of these side effects has led to increased attention on the development of alternative treatments for chronic pain. This book not only offers a single, comprehensive source for understanding the specialized nature of the opioid crisis, but also addresses provocative topics including how pain drugs came to be regulated by the US government and the rarely discussed aggressive marketing behind the spread of these drugs. Chapters are written by expert contributors from diverse backgrounds in medicine, psychiatry, pharmacy, nursing, law, and bioethics. Prescription Drug Diversion and Pain is a must-read for healthcare professionals, chronic pain patients and caregivers, policymakers and regulatory officials, drug treatment providers, and those in the pharmaceutical industry seeking to address the current opioid crisis.Less