Concepts Of Chemical Dependency

Description

CONCEPTS OF CHEMICAL DEPENDENCY, 10th Edition, provides comprehensive coverage and the latest information on a spectrum of substance use disorders and the compounds commonly misused. Author Harold Doweiko also covers topics not usually discussed in other substance abuse texts, including anabolic steroids, inhalants, infectious diseases associated with substance misuse, the medical marijuana debate and how the "war on drugs" has contributed to the problem of substance use disorders. Students report that they appreciate the balanced approach, which allows them to form their own opinions and doesn't preach that "drugs are bad for you." This edition includes new information on synthetic drugs, updates reflecting new preferred language in referring to those who struggle with substance use disorders and a new chapter on substance use and misuse in older adults. 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