The phenomenon of drug abuse is part of the human experience that extends as far back in time as recorded history exists. Today, however, it has a new and much greater dramatic urgency. The reasons for this are multiple and worrisome. Last year, of the total of approximately 1.9 million total deaths that occurred in the United States, a conservative estimate is that more than one-quarter were premature deaths due to the addictive disorders. These include over 300,000 deaths related to cigarette smoking, which represents in many respects the prototypic addiction in this country; over 200,000 deaths related to alcohol, and many more related to multiple other drugs—licit and illicit—that are abused in this society.

 

Twenty-five years ago, drug use was essentially unknown in our school age population. In 1960, a tragic increase of drug use in our young people began, so that by 1978 more high school seniors were current users of marijuana than of cigarettes. Despite the fact that the use of most drugs by high school populations appears to have peaked in the late 1970s and to be decreasing at the present time, most experts still believe that drug use by American young people represents the highest level of that found in any Western developed country.

 

There are important demographic changes taking place in the United States which suggest that during the next fifteen years, the level use of drugs in this country may decrease. On the other hand, at the same time, we are in the midst of a period of even more rapid discovery of increasingly powerful psychoactive drugs. Each such discovery, given the increasing technical proficiency which simplifies their production, increases the number of substances which will likely be abused in the future; thus, the potential dimensions of this problem are, in many respects, on a growth curve.

 

There has been an explosive increase not only in the dimensions and complexity of the problem of drug use and abuse in this country and in the world during the past two decades, but, in parallel, an explosive increase in our knowledge concerning these phenomena. For the first time, we have begun to understand the biology of behavior and, as great strides have been made in the study of brain/behavior relationships, we find that many of the drugs which are most subject to abuse and involved in addictive behaviors are drugs that play a key role in the biology of affect and reinforcement. Thus, for example, the discovery of the body's own morphine-like compounds—the endorphins and the enkephalins—have led for the first time to the development of eventually testable hypotheses which define a biological set of mechanisms, related to reward and reinforcement systems, that can explain narcotic addiction. Some investigators have suggested that disorders in the production, metabolism, or receptor sensitivity to endorphins may, in a pattern not unlike the body's handling of insulin in diabetes, be one of the factors that contributes to increased vulnerability to narcotic addiction among certain individuals or subpopulations. I am not suggesting here that this is likely to be demonstrated; I merely use it as an example of a new kind of hypothesis, testable eventually by empiric data, which was not available to us a decade ago.

 

The National Institute on Drug Abuse is proud of the key role it played in helping to encourage and support a wide range of basic biological, social, and psychobehavioral research, many of the fruits of which are reflected in the following chapters. The Institute looks forward to playing a similar role in the future. We anticipate further and accelerated advances in the areas of knowledge development and knowledge application, to the end of understanding and helping society to control and ameliorate the major problems associated with drug abuse in the twentieth century.

 

William Pollin, M.D.

Director, National Institute on Drug Abuse