Concepts of Chemical Dependency

by DOWEIKO

Edition:

4th

ISBN13:

9780534357559

ISBN10:

0534357555

Format:

Paperback

Pub. Date:

7/3/1998

Publisher(s):

Brooks Cole

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Summary

This thoroughly revised and updated edition reflects the current explosion of information regarding the understanding, identification, and treatment of addictive disorders. Doweiko offers detailed coverage of the most commonly abused chemicals and their effects, covering a single facet of a drug or alcohol problem in each focused chapter.

Doweiko covers topics frequently left out of other books, such as aerosols, steroids, and over-the-counter analgesics. In addition, you'll find in-depth coverage of such topics as the differences between abusers and addicts; drug effects on children, teenagers, and pregnant and nursing women; and children of alcoholics.

1 Recreational Chemical Use in the United States

(10)

Who "Treats" Those Who Are Addicted to Chemicals?

(1)

The Scope of the Problem of Chemical Abuse and Addiction

(5)

The Cost of Chemical Abuse and Addiction in the United States

(2)

Why Is It So Difficult to Understand the Drug Abuse Problem in the United States?

(1)

Summary

(1)

2 Substance Abuse and Addiction

(8)

The Continuum of Chemical Use

(2)

Definitions of Terms Used in This Book

(2)

The Growth of New "Addictions"

(1)

What Do We Really Know about the Addictive Disorders?

(1)

The State of the Art: Unanswered Questions, Uncertain Answers

(2)

Summary

(1)

3 An Introduction to Pharmacology

(15)

Drug Forms and How Drugs Are Administered

(2)

Bioavailability

(5)

The Drug Half-Life

(1)

The Effective Dose

(1)

The Lethal Dose Index

(1)

The Therapeutic Index

(1)

Peak Effects

(1)

The Site of Action

(1)

Receptor Sites

(2)

The Blood-Brain Barrier

(1)

Summary

(1)

4 An Introduction to Alcohol

(12)

A Brief History of Alcohol

(1)

How Alcohol Is Produced

(1)

Alcohol Today

(1)

Scope of the Problem of Alcohol Use

(1)

The Pharmacology of Alcohol

(2)

The Biotransformation of Alcohol

(1)

The Blood Alcohol Level

(1)

Subjective Effects of Alcohol

(1)

Effects of Intoxicating Doses of Alcohol for the Average Drinker

(1)

Medical Complications of Alcohol Use in the Average Drinker

(3)

Alcohol Use and Accidental Injury or Death

(1)

Summary

(1)

5 Chronic Alcohol

(19)

Scope of the Problem

(1)

The "Typical" Alcohol-Dependent Person

(1)

Alcohol Tolerance, Dependence, and Craving: Signposts of Addiction

(2)

Complications of Chronic Alcohol Use

(15)

Summary

(1)

6 Barbiturates and Barbituratelike Drugs

(11)

Early Pharmacological Therapy of Anxiety Disorders and Insomnia

(1)

History and Current Medical Uses of the Barbiturates

(1)

The Pharmacology of Barbiturates

(2)

Subjective Effects of Barbiturates at Normal Dosage Levels

(1)

Complications of the Barbiturates at Normal Dosage Levels

(2)

Effects of the Barbiturates at Above-Normal Dosage Levels

(1)

Tolerance of and Dependence on Barbiturates

(1)

Barbituratelike Drugs

(2)

Summary

(1)

7 Benzodiazepines and Similar Agents

(17)

Medical Uses of the Benzodiazepines

(1)

Pharmacology of the Benzodiazepines

(3)

Benzodiazepine Tolerance, Abuse, and Addiction

(2)

Complications Caused by Benzodiazepine Use at Normal Dosage Levels

(3)

Subjective Experience of Benzodiazepine Use

(1)

Long-Term Consequences of Chronic Benzodiazepine Use

(2)

Buspirone: The First Decade

(2)

Zolpidem

(1)

Rohypnol: A New Drug of Abuse

(1)

Summary

(1)

8 Amphetamines and Central Nervous System Stimulants

(13)

The Amphetaminelike Drugs

(1)

The Amphetamines

(2)

Scope of the Problem of Stimulant Abuse and Addiction

(1)

Medical Uses of Amphetamines and CNS Stimulants

(1)

Pharmacology of the Amphetamines

(2)

Methods of Amphetamine Abuse

(1)

Subjective Experience of Amphetamine Use

(1)

Side Effects of Amphetamine Use at Normal Dosage Levels

100

(1)

Consequences of Amphetamine Abuse

100

(3)

"Ice"

103

(1)

"Kat"

104

(1)

Summary

105

(1)

9 Cocaine

106

(18)

A Brief Overview of Cocaine

106

(1)

Cocaine in Recent U.S. History

107

(1)

Current Medical Uses of Cocaine

108

(1)

Scope of the Problem of Cocaine Abuse and Addiction

108

(1)

Pharmacology of Cocaine

109

(2)

How Illicit Cocaine Is Produced

111

(1)

How Cocaine Is Abused

112

(2)

Effects of Cocaine Subjective When It Is Abused

114

(1)

Complications of Cocaine Abuse/Addiction

115

(6)

Withdrawal and Recovery from Central Nervous System Stimulant Abuse

121

(2)

Summary

123

(1)

10 Marijuana

124

(11)

History of Marijuana Use in the United States

124

(2)

Marijuana--Technically a Plant, Not a Drug

126

(1)

Scope of the Problem

126

(1)

Pharmacology of Marijuana

127

(1)

Methods of Administration

128

(1)

Subjective Effects of Marijuana

129

(1)

Adverse Effects of Occasional Marijuana Use

130

(1)

Consequences of Chronic Marijuana Use

130

(3)

The Addiction Potential of Marijuana

133

(1)

The Treatment of Marijuana Abuse/Addiction

134

(1)

Summary

134

(1)

11 Opiate

135

(20)

I. The Medical Uses of Narcotic Analgesics

135

(10)

A Short History of the Narcotic Analgesics

135

(2)

The Classification of Analgesics

137

(1)

Where Opium Is Produced

137

(1)

Current Medical Uses of the Narcotic Analgesics

137

(1)

Pharmacology of the Narcotic Analgesics

138

(3)

Subjective Effects of Narcotic Analgesics When Used in Medical Practice

141

(1)

Complications Caused by Narcotic Analgesics When Used in Medical Practice

141

(2)

Fentanyl

143

(1)

Buprenorphine

144

(1)

II. Opiates as Drugs of Abuse

145

(10)

Overview

145

(2)

Methods of Opiate Abuse

147

(1)

Scope of the Problem of Opiate Abuse and Addiction in the United States

148

(4)

Complications Caused by Opiate Abuse and Addiction

152

(1)

Opiate Overdose

153

(1)

Is Treatment of Opiate Addiction Worthwhile?

154

(1)

Summary

154

(1)

12 Over-the-Counter Analgesics

155

(18)

A Short History of Pain Management

155

(2)

Medical Uses of the OTC Analgesics

157

(3)

Pharmacology of the OTC Analgesics

160

(3)

Normal Dosage Levels of Over-the-Counter Analgesics

163

(2)

Complications Caused by Use of Over-the-Counter Analgesics

165

(5)

Overdose of OTC Analgesics

170

(2)

Summary

172

(1)

13 Hallucinogens

173

(14)

Scope of the Problem

174

(1)

Pharmacology of the Hallucinogens

174

(2)

Subjective Effects of Hallucinogens

176

(2)

Phencyclidine (PCP)

178

(3)

Complications of PCP Abuse

181

(1)

Ecstasy: Latest in a Long Line of "Better" Hallucinogens?

182

(4)

Summary

186

(1)

14 Inhalants and Aerosols

187

(8)

The History of Inhalant Abuse

187

(1)

The Pharmacology of the Inhalants

188

(1)

Scope of the Problem

189

(2)

Method of Administration

191

(1)

Subjective Effects of Inhalants

191

(1)

Complications from Inhalant Abuse

191

(2)

Anesthetic Misuse

193

(1)

Abuse of Nitrites

194

(1)

Summary

194

(1)

15 Anabolic Steroids

195

(8)

An Overview of the Anabolic Steroids

195

(1)

Medical Uses of Anabolic Steroids

196

(1)

The Legal Status of Anabolic Steroids

196

(1)

Scope of the Problem of Steroid Abuse

196

(1)

Sources and Methods of Steroid Abuse

196

(1)

Problems Associated with Anabolic Steroid Abuse

197

(1)

Complications of Steroid Abuse

198

(3)

Are Anabolic Steroids Addictive?

201

(1)

The Treatment of Anabolic Steroid Abuse

202

(1)

Summary

202

(1)

16 Tobacco Products and Nicotine

203

(20)

Scope of the Problem

204

(1)

Pharmacology of Cigarette Smoking

205

(4)

Subjective Effects of Nicotine Use

209

(1)

Nicotine Addiction

210

(3)

Complications of the Chronic Use of Tobacco

213

(7)

The Treatment of Nicotine Addiction

220

(2)

Summary

222

(1)

17 The Medical Model of Chemical Addiction

223

(14)

Why Do People Use Chemicals?

223

(1)

Factors That Influence Recreational Drug Use

223

(5)

What Do We Mean When We Say That Someone Is Addicted to Chemicals?

228

(1)

The Medical Model of Drug Addiction

229

(6)

The Personality Predisposition Theories of Substance Abuse

235

(1)

Summary

236

(1)

18 Are People Predestined to Become Addicted to Chemicals?

237

(14)

Reaction against the Disease Model of Addiction

237

(5)

Then What Exactly Are the Addictive Disorders?

242

(4)

The Personality Predisposition Theories of Substance Abuse

246

(2)

The Final Common Pathway Theory of Addiction

248

(2)

Summary

250

(1)

19 Addiction as a Disease of the Human Spirit

251

(12)

Diseases of the Mind--Diseases of the Spirit: The Mind-Body Question

252

(1)

The Growth of Addiction: The Circle Narrows

253

(1)

The Circle of Addiction: The Addicted Priorities

254

(1)

Some Games of Addiction

255

(2)

Honesty as a Part of the Recovery Process

257

(1)

False Pride: The Disease of the Spirit

258

(2)

Denial, Rationalization, Projection, and Minimization: The Four Musketeers of Addiction

260

(2)

Summary

262

(1)

20 Chemicals and the Neonate

263

(16)

Statement of the Problem

264

(1)

The Fetal Alcohol Syndrome

264

(2)

Cocaine Use during Pregnancy

266

(4)

Amphetamine Use during Pregnancy

270

(1)

Narcotic Analgesic Use during Pregnancy

271

(2)

Marijuana Use during Pregnancy

273

(1)

Benzodiazepine Use during Pregnancy

274

(1)

Hallucinogen Use during Pregnancy

274

(1)

Buspirone Use during Pregnancy

274

(1)

Bupropion Use during Pregnancy

274

(1)

Disulfiram Use during Pregnancy

275

(1)

Cigarette Use during Pregnancy

275

(1)

Over-the-Counter Analgesic Use during Pregnancy

276

(1)

Inhalant Abuse during Pregnancy

277

(1)

Blood Infections

278

(1)

Summary

278

(1)

21 Hidden Faces of Chemical Dependency

279

(13)

Women and Addiction: An Often Unrecognized Problem

279

(3)

Differing Effects of Common Drugs of Abuse on Men and Women

282

(2)

Addiction and the Elderly

284

(4)

The Homosexual and Substance Abuse

288

(2)

Substance Abuse and the Disabled

290

(1)

Substance Abuse and Ethnic Minorities

290

(1)

Summary

291

(1)

22 The Dual-Diagnosis Client

292

(12)

Definitions

292

(1)

Dual-Diagnosis Clients: A Diagnostic Challenge

293

(1)

Why Worry about the Dual-Diagnosis Client?

294

(1)

The Scope of the Problem

295

(1)

Characteristics of Dual-Diagnosis Clients

295

(3)

Problems in Working with Dual-Diagnosis Clients

298

(2)

Treatment Approaches

300

(3)

Summary

303

(1)

23 Chemical Abuse by Children and Adolescents

304

(18)

Scope of the Problem

305

(5)

Tobacco Use by Children and Adolescents

310

(2)

Why Do Adolescents Use Chemicals?

312

(2)

The Adolescent Abuse/Addiction Dilemma: Or, How Much Is Too Much?

314

(5)

Possible Diagnostic Criteria for Adolescent Drug/Alcohol Problems

319

(1)

The Special Needs of the Adolescent in a Substance Abuse Rehabilitation Program

320

(1)

Summary

321

(1)

24 Codependency and Enabling

322

(12)

Enabling

322

(3)

Codependency

325

(5)

Reactions to the Concept of Codependency

330

(3)

Summary

333

(1)

25 Addiction and the Family

334

(13)

Scope of the Problem

335

(1)

Addiction and Marriage

335

(2)

Addiction and the Family

337

(3)

The Adult Child of Alcoholics (ACOA) Movement

340

(5)

Summary

345

(2)

26 The Evaluation of Substance Use Problems

347

(17)

The Theory behind Alcohol and Drug Use Evaluations

347

(1)

Screening

348

(2)

Assessment

350

(1)

Diagnosis

351

(1)

The Assessor and Data Privacy

352

(1)

Diagnostic Rules

353

(2)

The Assessment Format

355

(5)

Other Sources of Information: Medical Test Data

360

(1)

Psychological Test Data

361

(1)

The Outcome of the Evaluation Process

362

(2)

27 The Process of Intervention

364

(10)

A Definition of Intervention

364

(1)

Characteristics of the Intervention Process

365

(1)

The Mechanics of Intervention

365

(4)

Intervention and Other Forms of Chemical Addiction

369

(1)

The Ethics of Intervention

369

(1)

Legal Intervention

370

(1)

Treatment or Incarceration: When Is Treatment Appropriate?

371

(1)

Other Forms of Intervention

372

(1)

Summary

373

(1)

28 The Treatment of Chemical Dependency

374

(10)

Characteristics of the Substance Abuse Rehabilitation Professional

374

(1)

Confrontation and Other Treatment Techniques

375

(1)

The Minnesota Model of Chemical Dependency Treatment

376

(1)

The Treatment Plan

377

(1)

Other Treatment Formats for Chemical Dependency

378

(5)

Aftercare Programs

383

(1)

Summary

383

(1)

29 Treatment Formats for Chemical Dependency Rehabilitation

384

(13)

Outpatient Treatment Programs

384

(3)

Impatient Treatment Programs

387

(2)

Is There a Legitimate Need for Inpatient Treatment?

389

(3)

Inpatient or Outpatient Treatment?

392

(4)

Summary

396

(1)

30 Recovery

397

(9)

The Stages of Recovery

397

(4)

Should Abstinence Be the Goal of Treatment?

401

(1)

Specific Points to Address with Common Drugs of Abuse

401

(4)

Summary

405

(1)

31 Problems in Treating Chemical Dependency

406

(15)

Limit Testing by Clients in Treatment

406

(1)

Treatment Noncompliance

407

(1)

Relapse and Relapse Prevention

407

(4)

Chemical Use--Craving and Urges

411

(1)

Controlled Drinking

412

(1)

Clients Who Appear for Their Appointment while under the Influence of Chemicals

413

(1)

Toxicology Testing as a Measure of Treatment Compliance and Drug Use

413

(5)

Insurance Reimbursement Policies

418

(2)

Summary

420

(1)

32 Pharmacological Intervention Tactics and Substance Abuse

421

(17)

The Pharmacological Treatment of Alcohol Abuse and Dependence

421

(5)

The Pharmacological Treatment of Narcotics Addiction

426

(4)

LAAM

430

(1)

The Pharmacological Treatment of Cocaine Addiction

431

(3)

Pharmacological Treatment of Nicotine Dependence

434

(3)

Summary

437

(1)

33 Infections Frequently Caused by Recreational Substance Abuse

438

(16)

Why Is Infectious Disease Such a Common Complication of Alcohol/Drug Abuse?

438

(2)

Acquired Immune Deficiency Syndrome (AIDS)

440

(9)

Tuberculosis (TB)

449

(1)

Viral Hepatitis

450

(3)

Summary

453

(1)

34 Crime and Drug Use

454

(19)

Scope of the Problem of Drug-Related Criminal Behavior

454

(3)

The Drug Underworld and Crime

457

(3)

The Dilemma of Drug-Related Criminal Activity

460

(1)

The "War on Drugs": Is It Time to Declare a Winner?

460

(1)

Should Drugs Be Legalized?

461

(4)

Drug Use and Violence: The Unseen Connection

465

(1)

Unseen Victims of Street Drug Chemistry

466

(1)

Drug Analogs: The "Designer" Drug

467

(3)

GHB

470

(1)

Summary

471

(2)

35 Self-Help Groups

473

(14)

The Twelve Steps of Alcoholics Anonymous

473

(1)

The History of AA

474

(1)

Elements of AA

474

(2)

AA and Religion

476

(1)

One "A" Is for Anonymous

476

(1)

AA and Outside Organizations

477

(1)

The Primary Purpose of AA

477

(2)

Of AA and Recovery

479

(1)

Sponsorship

479

(1)

AA and Psychological Theory

480

(1)

How Does AA Work?

480

(1)

Outcome Studies: The Effectiveness of AA

481

(2)

Narcotics Anonymous

483

(1)

Al-Anon and Alateen

484

(1)

Support Groups Other than AA

484

(2)

Summary

486

(1)

Appendix 1 Sample Assessment: Alcohol Abuse Situation

487

(4)

Appendix 2 Sample Assessment: Chemical Dependency Situation

491

(5)

References

496

(49)

Index

545

Concepts of Chemical Dependency

9780534357559

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Table of Contents