Concepts Of Chemical Dependency

Cover......Page 1
Brief Contents......Page 7
Contents......Page 8
Preface......Page 16
Chapter 1: Why Worry about Substance Misuse or Substance Use Disorders?......Page 18
SUDs as Unsuspected Influences on Society......Page 19
The Scope of the Problem of the SUDs......Page 20
The Cost of Chemical Misuse and SUDs......Page 23
Who Treats Persons with an SUD?......Page 24
Chapter Summary......Page 25
Chapter 2: The Nature of the Beast......Page 26
Why Do People Choose to Use Drugs or Alcohol?......Page 27
The Continuum of Chemical Use......Page 29
What Do We Mean When We Say That Somebody Is "Addicted" to a Chemical?......Page 30
Definitions of Terms Used in This Text......Page 31
Unanswered Questions......Page 32
Chapter Summary......Page 33
A Basic Misconception......Page 34
The Method by Which a Compound Is Administered......Page 35
Bioavailability......Page 37
The Lethal Dose and Therapeutic Index......Page 42
The Receptor Site......Page 43
The Process of Neurotransmission......Page 44
Chapter Summary......Page 46
Chapter 4: An Introduction to Alcohol: Man's Oldest Recreational Chemical......Page 47
A Brief History of Alcohol......Page 48
A Working Definition of Social Drinking......Page 50
Scope of Alcohol Use in the World Today......Page 51
The Pharmacology of Ethyl Alcohol......Page 52
The Biotransformation of Alcohol......Page 53
The Blood Alcohol Level (BAL)......Page 54
Subjective Effects of Alcohol on the Individual Who Drinks Socially at Normal Doses......Page 55
Medical Complications of Alcohol Use for the Individual Who Drinks Socially......Page 56
Chapter Summary......Page 62
Chapter 5: The Alcohol Use Disorders......Page 63
Scope of the Problem......Page 64
Who Is the Typical Person with an Alcohol Use Disorder?......Page 65
Physical Dependence, Tolerance, and "Craving"......Page 66
Complications of Chronic Alcohol Use......Page 67
The Alcohol Withdrawal Syndrome......Page 77
Chapter Summary......Page 79
Early Medical Treatment of Anxiety and Insomnia......Page 80
History and Current Medical Uses of Barbiturates......Page 81
Pharmacology of the Barbiturates......Page 82
Complications of Barbiturate Use at Normal Dosage Levels......Page 84
Effects of the Barbiturates at Above-Normal Dosage Levels......Page 85
The Barbiturate-Like Drugs......Page 86
Chapter Summary......Page 87
Chapter 7: Misuse of the Benzodiazepines and Similar Agents......Page 89
The Pharmacology of the Benzodiazepines......Page 90
Subjective Effects of Benzodiazepines at Normal Dosage Levels......Page 92
Side Effects of the Benzodiazepines When Used at Normal Dosage Levels......Page 93
Neuroadaptation to, Misuse of, and Addiction to the Benzodiazepines......Page 94
Long-Term Consequences of Chronic Benzodiazepine Use......Page 97
The Benzodiazepine Receptor Antagonists (Z-Compounds or BRAs)......Page 98
Rohypnol......Page 102
Chapter Summary......Page 103
Chapter 8: Use and Misuse of Central Nervous System Stimulants......Page 104
I. CNS Stimulants as Used in Medical Practice......Page 105
II. CNS Stimulant Misuse......Page 112
CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition......Page 121
Chapter Summary......Page 122
Chapter 9: Cocaine Misuse and Cocaine Use Disorder......Page 123
A Brief History of Cocaine......Page 124
Scope of the Problem of the Cocaine Use Disorders......Page 125
Pharmacology of Cocaine......Page 126
Methods of Cocaine Misuse......Page 128
Complications of Cocaine Misuse and Cocaine Use Disorder......Page 130
Chapter Summary......Page 135
Chapter 10: Marijuana Use and Misuse......Page 136
Anecdotal Claims of Efficacy......Page 137
A Technical Point......Page 138
The Pharmacology of Marijuana......Page 139
Methods of Marijuana Use......Page 142
Subjective Effects of Marijuana Use......Page 143
Adverse Effects of Marijuana Misuse......Page 144
Chapter Summary......Page 150
Chapter 11: Opioid Use and Misuse......Page 151
A Short History of the Natural and Synthetic Opioids......Page 152
I. The Medical Applications of Narcotic Analgesics......Page 153
II. Opiates as Drugs of Misuse......Page 166
Opioid Use or Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition......Page 174
Chapter Summary......Page 175
Chapter 12: Hallucinogen Misuse......Page 176
A Short History of Hallucinogens......Page 177
Pharmacology of the Hallucinogens......Page 178
The Pharmacology of LSD......Page 179
The Subjective Effects of LSD......Page 180
Phencyclidine (PCP)......Page 183
Complications of PCP Use......Page 184
Ecstasy (MDMA)......Page 185
Subjective and Objective Effects of MDMA Use......Page 188
Complications of MDMA Misuse......Page 189
Salvia Divinorum......Page 192
Chapter Summary......Page 193
A Brief History of Inhalant Use......Page 194
The Pharmacology of the Inhalants......Page 195
Scope of the Problem of Inhalant Misuse......Page 196
Subjective Effects of Inhalants......Page 197
Complications Induced by Inhalant Misuse......Page 198
Anesthetic Misuse......Page 199
Inhalant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition......Page 200
Chapter Summary......Page 201
Chapter 14: The Under-Recognized Problem of Steroid Misuse......Page 202
An Introduction to the Anabolic-Androgenic Steroids......Page 203
Scope of the Problem of Steroid Misuse......Page 204
Pharmacology of Anabolic-Androgenic Steroids......Page 205
Sources and Methods of Steroid Misuse......Page 206
Known Adverse Effects of Anabolic Steroids When Misused......Page 207
Are Anabolic Steroids Addictive?......Page 209
Are Misused Steroids Effective?......Page 210
Chapter Summary......Page 211
Chapter 15: Tobacco Products and Tobacco Use......Page 212
Scope of the Problem of Tobacco Use......Page 213
The Pharmacology of Cigarette Smoking......Page 214
The Effects of Nicotine on the Body......Page 217
Complications of Long-Term Use of Tobacco Products......Page 219
Secondhand Smoke......Page 223
Smoking Cessation......Page 225
Chapter Summary......Page 227
A Short History of the OTC Analgesics......Page 228
Medical Uses of the OTC Analgesics......Page 229
Normal Dosage Levels of the OTC Analgesics......Page 231
Pharmacology of OTC Analgesics......Page 232
Complications Caused by OTC Analgesic Use......Page 234
OTC Overdoses......Page 237
Over-the-Counter Analgesic Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition)......Page 238
Chapter Summary......Page 239
Chapter 17: Chemicals and the Neonate......Page 240
Scope of the Problem......Page 241
Alcohol......Page 242
Use of Amphetamines and Amphetamine-Like Compounds during Pregnancy......Page 245
Benzodiazepine Use during Pregnancy......Page 246
Cigarette Smoking during Pregnancy......Page 247
Cocaine Use during Pregnancy......Page 248
Inhalant Misuse during Pregnancy......Page 249
Marijuana Use during Pregnancy......Page 250
Narcotic Analgesic Use during Pregnancy......Page 251
Over-the-Counter Analgesics Use during Pregnancy......Page 253
Chapter Summary......Page 254
Gender and Addiction: The Lessons of History......Page 255
Substance Use Disorders in Women......Page 256
Does Gender Affect the Rehabilitation Process?......Page 257
Alcohol Use Disorders in Women......Page 259
Benzodiazepine Misuse by Women......Page 262
Hallucinogen Misuse by Women......Page 263
Narcotics Misuse by Women......Page 264
Nicotine Misuse by Women......Page 265
Chapter Summary......Page 267
Substance Use Disorders and the Homeless......Page 268
Substance Use Disorders in the Military......Page 269
Substance Use Disorders in the Lesbian, Gay, Bisexual, and Transgender Communities......Page 270
Substance Misuse and Individuals with a Disability......Page 272
Ethnic Minorities and Substance Use Disorders......Page 273
Chapter Summary......Page 276
Chapter 20: Substance Misuse by Children and Adolescents......Page 277
The Problem of Substance Use and Substance Use Disorders in Childhood and Adolescence......Page 278
Scope of the Problem of Substance Use in Childhood and Adolescence......Page 279
Why Worry about Substance Use Disorders in Childhood and Adolescence?......Page 282
Tobacco Use by Children and Adolescents......Page 285
Why Do Children and Adolescents Use Chemicals?......Page 286
Substance Use: How Much and When Does It Become Too Much?......Page 293
Screening/Assessment Tools......Page 296
Possible Diagnostic Criteria for Children or Adolescents with Suspected SUDs......Page 297
Consequences of a Substance Use Disorder in a Child or Adolescent......Page 298
Adolescent Rehabilitation Programs......Page 301
Chapter Summary......Page 304
Chapter 21: Substance Use and Substance Use Disorders in College Students......Page 305
A Special Environment......Page 306
Scope of the Problem......Page 308
Consequences of Substance Use Disorders in the College Population......Page 311
Are There Forces That Help Protect the Student from SUDs?......Page 313
Chapter Summary......Page 314
Chapter 22: Substance Use Disorders and the Older Adult......Page 315
Scope of the Problem......Page 316
Why Is the Detection of SUDs in Older Adults So Difficult?......Page 317
Prescription Drug Misuse......Page 318
The Treatment of Older Patients with SUDs......Page 319
Chapter Summary......Page 320
Chapter 23: Substance Use Disorders and the Family......Page 321
Addiction and the Family Unit......Page 322
The Adult Children of Alcoholics (ACOA) Movement......Page 326
Chapter Summary......Page 329
Enabling......Page 330
Codependency......Page 331
Reactions to the Concept of Codependency......Page 336
Chapter Summary......Page 338
Chapter 25: The Client with Co-Occurring Disorders......Page 340
Definitions......Page 341
Clients with Co-Occurring Disorders: A Diagnostic Challenge......Page 342
Scope of the Problem......Page 343
Psychopathology and Drug of Choice......Page 345
Problems in Working with the Client with Co-Occurring Disorders......Page 354
Treatment Approaches with Clients with Co-Occurring Disorders......Page 357
Chapter Summary......Page 359
Chapter 26: The Biopsychosocial Model of the Addictions......Page 360
I. Biology: The "Bio" Part of the Bio/Psycho/Social Model......Page 361
Reactions against the Biological Component of the Bio/Psycho/Social Model......Page 368
II. The Psychological Components of the Bio/Psycho/Social Model......Page 375
Applications of the Psychological Component of the Bio/Psycho/Social Model......Page 379
Reactions against the Psychological Models of the Substance Use Disorders......Page 380
III. The Social Component of the Bio/Psycho/Social Model......Page 382
Applications of the Social Component of the Bio/Psycho/Social Model......Page 390
Psycho-Educational Intervention Programs......Page 391
Chapter Summary......Page 392
The Individual: The Starting Point......Page 393
Spirituality......Page 395
Diseases of the Spirit......Page 399
The Benefits of Spirituality......Page 403
The Addictions as a Disease of the Spirit......Page 404
Chapter Summary......Page 405
Chapter 28: The Assessment of Suspected Substance Use Disorders......Page 406
Screening......Page 407
Assessment......Page 411
The Assessment Format......Page 414
Diagnostic Rules......Page 417
Other Sources of Information: Medical Test Data......Page 418
Diagnosis: The Outcome of the Assessment Process......Page 419
Chapter Summary......Page 421
Chapter 29:  Intervention......Page 422
A Brief History of Intervention......Page 423
The Mechanics of Intervention......Page 424
The Ethics of Intervention......Page 425
Some Common Forms of Intervention......Page 426
Chapter Summary......Page 430
Chapter 30: Treatment Settings......Page 432
An Introduction to Outpatient Treatment......Page 433
Introduction to Residential Treatment Programs......Page 435
Is There a Legitimate Need for Inpatient Treatment?......Page 437
Aftercare Programs......Page 438
Chapter Summary......Page 439
Chapter 31: The Treatment of Substance Use Disorders......Page 441
Characteristics of the Substance Rehabilitation Professional......Page 442
The Minnesota Model of Substance Use Treatment......Page 443
Other Treatment Formats for Substance Use Disorders......Page 445
The Treatment Plan......Page 451
Chapter Summary......Page 453
Chapter 32: The Process of Treatment......Page 454
Methods of Treatment......Page 455
The Stages of Recovery......Page 456
Specific Points to Address in Substance Rehabilitation......Page 461
Chapter Summary......Page 464
Chapter 33: Pharmacological Interventions for Substance Use Disorders......Page 465
Pharmacological Treatment of Alcohol Use Disorders......Page 466
Pharmacological Treatment of Stimulant Use Disorders......Page 472
Pharmacological Interventions for Cocaine Use Disorders......Page 473
Pharmacological Treatment of Marijuana Use Disorders......Page 474
Pharmacological Treatment of Opioid Use Disorders......Page 475
Pharmacological Treatment of the Tobacco Use Disorders......Page 482
Chapter Summary......Page 485
Common Problems......Page 487
Switching Addictions......Page 489
Lapse and Relapse......Page 490
Pain......Page 495
Controlled Drinking......Page 498
"Cravings" and "Urges"......Page 499
The "Using" Dream......Page 500
Toxicology Testing......Page 501
Funding......Page 507
Chapter Summary......Page 509
Chapter 35: Support Groups to Promote and Sustain Recovery......Page 510
Elements of AA......Page 511
The Relationship between Alcoholics Anonymous and Religion......Page 513
Alcoholics Anonymous and Outside Organizations......Page 514
Outcome Studies: The Effectiveness of Alcoholics Anonymous......Page 515
Other 12-Step Groups......Page 517
Support Groups Other Than 12-Step Groups......Page 518
Challenges to the Traditional 12-Step Movement......Page 520
Chapter Summary......Page 522
Chapter 36: Substance Use Disorders and Infectious Disease......Page 524
Assorted Bacterial Infections Seen in Individuals Using Intravenous Drugs......Page 525
The Pneumonias......Page 526
Tuberculosis......Page 527
Acquired Immune Deficiency Syndrome (AIDS)......Page 529
Viral Hepatitis......Page 534
Chapter Summary......Page 538
Harry Anslinger......Page 539
Criminal Activity and Drug Misuse: Partners in a Dance, but Who Is Leading?......Page 542
Drug Use and Violence: The Unseen Connection......Page 544
Adulterants......Page 546
"Designer" Drugs......Page 548
Some Existing Drug Analogs......Page 549
Designer Narcotics......Page 556
Atypical Compounds of Misuse......Page 558
Chapter Summary......Page 559
Chapter 38: The Debate over Legalization......Page 560
The "War" on Drugs: An Ongoing National Disaster......Page 561
The Reality of the War on Drugs......Page 566
The Debate over "Medical Marijuana"......Page 569
Legalization of Marijuana......Page 571
Chapter Summary......Page 572
Appendix 1: The Diagnostic and Statistical Manual of Mental Disorders (5th Edition) (DSM-5) and Substance Use Disorders......Page 574
Appendix 2: Drug Classification Schedules......Page 576
Appendix 3: The Twelve Steps of Alcoholics Anonymous......Page 577
Appendix 4: The "Jellinek" Chart for Alcoholism......Page 578
Glossary......Page 579
References......Page 591
Index......Page 666