Alcohol and Tobacco: Medical and Sociological Aspects of Use, Abuse and Addiction

Cover......Page 1
Alcohol and Tobacco......Page 3
ISBN 9783709101452......Page 4
Acknowledgements......Page 6
Foreword......Page 8
Foreword......Page 10
Table of contents......Page 12
1 Information about the origination of this book......Page 20
1.1 Aims of this book......Page 21
1.2 Personal reasons for the  rstauthor writing this book......Page 22
2.1 Introduction......Page 24
2.3 The Diagnosis addiction......Page 25
2.4 Aetiology of addiction......Page 26
2.5 Secondary disorders andaddiction......Page 27
2.8 Motivation of addicts......Page 28
2.10 Addiction and relapse......Page 29
2.11.2 Overweight, eating disorders......Page 30
2.13 Polytoxicomania......Page 31
2.14 Non-substance dependence......Page 32
3.2 Psychological theories......Page 34
3.2.1 Behavioural approaches......Page 35
3.2.2 Models of depth psychology......Page 36
3.2.4 Ego-psychological approaches......Page 37
3.2.6 Theoretical approach of Narcissism......Page 38
3.3 Social explanation approaches......Page 39
3.4.1 Important   ndings about tobaccoand alcohol use from basic research......Page 41
3.4.2 Aspects of alcohol and tobaccometabolism......Page 42
3.4.3 Maternal tobacco and alcohol useduring pregnancy: a risk factor for the offspring?......Page 44
3.5 Aetiological aspects of tobaccoand alcohol dependence from anepidemiological perspective......Page 49
3.6 Aetiology of addiction from apsychiatric perspective......Page 52
4.1.1 Attitudes towards alcohol consumption......Page 56
4.1.2 Attitudes towards tobaccoconsumption......Page 58
4.2 Primary prevention of tobaccoand alcohol addiction......Page 59
4.3 Secondary prevention: earlydiagnosis and intervention......Page 61
4.3.1 Conclusions for secondaryprevention......Page 62
4.4 Tertiary prevention(see chapter 9)......Page 65
5.1 Problems concerningpsychiatric diagnoses......Page 66
5.2 Development of the term“addiction”......Page 67
5.3 Substance related diagnoses inthe ICD-10......Page 68
5.3.2 Dependence syndrome(ICD 10 F10.2, F 17.2 )......Page 69
5.3.3 Withdrawal state (ICD 10 F10.3)......Page 70
5.4.2 Diagnosis according to DSM-IV axis I......Page 71
5.4.3. Speci  ers de  ning subgroups ofdependence......Page 73
5.4.5 Withdrawal symptoms of tobaccoand alcohol......Page 74
5.6.1 Alcohol......Page 75
5.6.2 Tobacco......Page 80
6.1.1 Development of typology research......Page 82
6.1.2 Important typologies for researchand practice......Page 83
6.1.3 Assessment of severity in differentdimensions......Page 88
6.2.2 Smoking Typology according toFagerstroem......Page 90
6.2.3 European smoking classi  cationsystem......Page 92
6.3.1 Framework for the de  nition ofLesch’s typology......Page 93
6.3.3 The “Burgenland Modell”......Page 94
6.3.4 Methodology of the longitudinalstudy on alcohol dependent patients(according to DSM-III and ICD-9), used forthe development of Lesch’s typology......Page 96
6.3.5 Stability in the longitudinal course......Page 98
6.3.6 The four long-term illness coursesused for Lesch’s typology......Page 101
6.3.7 Results of studies using the Leschtypology......Page 103
6.3.8 Lesch’s typology from an internationalcomparative perspective......Page 110
6.4 The relationship betweenalcohol dependent patients accordingto Lesch’s typology and theseverity of tobacco addiction......Page 111
7.2 Alcohol addiction......Page 114
7.3.1 Tobacco and sequelae......Page 116
7.3.2 Alcohol and sequelae......Page 118
8.1 Recommendations for the   rstcontact......Page 138
8.2.2 State markers......Page 141
8.2.4 Practical suggestions for the use ofbiological markers for forensic purposes......Page 142
8.3 The clinical dialogue intobacco addiction......Page 148
9.1.1 Motivational interviewing at thegeneral practitioner’s......Page 150
9.1.4 Motivational interviewing inpsychiatric settings......Page 151
9.2.1 Alcohol addiction......Page 153
9.2.2 Tobacco addiction......Page 157
9.3.2 Therapy of withdrawal states......Page 160
9.3.3 Therapy of the withdrawal syndromesaccording to Lesch’s typology......Page 164
9.3.4 Complications in alcohol withdrawal......Page 170
9.4 Alternatives to withdrawal......Page 172
9.4.1 Gradual reduction of drinkingamount, “ Cut down drinking”,method according to David Sinclair......Page 173
9.4.2 Case study: “Cut down drinking”......Page 174
9.5 Pharmacotherapy of tobaccowithdrawal syndrome......Page 175
9.5.1 Symptoms of the tobaccowithdrawal syndrome......Page 176
9.5.2 Therapy of the tobacco withdrawalsyndrome......Page 177
9.6.1 General guidelines for relapseprevention......Page 178
9.6.2 Goals for relapse prevention......Page 179
9.6.3 Medication against so-called“ positive” craving (= desire forpleasurable, rewarding effects of theaddictive substance)......Page 180
9.6.4 Pharmacotherapy against theso-called “ negative” craving (= desire foraddictive substances to relieve negativemood and anxiety)......Page 181
9.6.5 Pharmacotherapy in relapseprevention in dependent patients......Page 182
9.6.6 Relapse prevention according toLesch’s typology......Page 183
9.6.7 Treatment of relapses according toLesch’s typology......Page 188
9.6.8 Pharmacotherapy of relapse preventionin tobacco dependents......Page 189
10.1 Alcohol and Tobacco......Page 198
10.2 The sociotherapeutic1 mission......Page 199
10.3 Classification Psychotherapy-Sociotherapy......Page 204
10.4.1 Primary, secondary and tertiarysociogenesis......Page 208
10.4.2 Sociological factors ona macro-level4......Page 209
10.4.3 Co-morbidity and marginal groupidentity......Page 214
10.4.4 The link between social relationships(factors on a social micro level),group coherence and resilience......Page 216
10.4.5 Analogy to Gerontology: an atrophyof the “ social atom”......Page 218
10.5.1 Socio therapy location(s)(Schwendter 2000)......Page 221
10.5.2 Therapeutic phases and settings......Page 222
10.6 State of the Art: overlappingperspectives for sociotherapeutichousing and support projects foralcohol dependents......Page 226
10.6.1 Standard categories......Page 227
10.6.2 Excursus: supported housingprojects – worlds of their own......Page 234
10.7.1 Ambivalent functions of motivation......Page 242
10.7.2 The relationship betweendependence and motivation systems......Page 245
10.8 Sociotherapy as networkpromoter......Page 247
10.8.1 Micro and meso levels ofnetworking......Page 248
10.8.2 Macro levels of networking......Page 254
10.9.1 The critical relationship between psychiatry and sociotherapy......Page 255
10.9.2 Application of the typology in sociotherapeutic contexts......Page 256
10.9.3 The relationship between type and self-regulation......Page 258
10.9.4 Types and aims of therapy......Page 262
10.9.5 Sociotherapeutic aspects oftherapy with alcohol dependents whoare fundamentally impaired in theirperformance......Page 265
Appendix 1 Lesch Alcoholism Typology –Questionnaire......Page 292
Appendix 2 Lesch European SmokerClassi cation......Page 302
Index......Page 366
About the Authors......Page 372