Recent-and exciting-discoveries of the neuropharmacology and psychopharmacology of addictive disorders make the Clinical Manual of Addiction Psychopharmacologyan essential guide to our understanding of this exceptionally challenging field. Written with a therapeutic focus as a clinical guide for the use of pharmacotherapy in patients with substance use disorders, the Clinical Manual of Addiction Psychopharmacologyoffers In-depth background discussion on each major class of drug and its treatment. Meticulously detailed reviews of the pharmacology of addictive drugs and the medications used to treat dependence on these addictive drugs. The latest work of 24 recognized experts from both the United States and abroad-all contributors to the empirical literature covered here. Nine chapters, highlighted by informative illustrations, covering all of the major classes of substances that are clinically important in relation to addiction: alcohol, opioids, sedative-hypnotics, cannabis, cocaine and psychostimulants, hallucinogens and phencyclidine, club drugs (gamma-hydroxybutyrate, ecstasy, and ketamine), inhalants, and tobacco. A discussion of psychosocial treatments combined with pharmacotherapy for alcohol, cocaine, and opioid use disorders. The goal of this approach is to optimize outcomes by understanding how patient characteristics, such as substance use disorder typology, severity, family history, and comorbid psychopathology, may interact with psychosocial and pharmacological treatment. Each chapter covers three primary aspects of a major drug group: an overview of the clinical pharmacology of the abused substance, phenomenology or pharmacological treatment or both of the abstinence syndrome, and pharmacological treatment for relapse prevention. For disorders in which no clear pharmacotherapy has proven effective (e.g., cocaine dependence), or for disorders in which no clear abstinence syndrome has been established (e.g., marijuana dependence), authors review the basic pharmacology of the drug and the phenomenology of withdrawal to enable clinicians to evaluate new clinical research in medications development for those disorders. An essential guide for clinical and social work, the Clinical Manual of Addiction Psychopharmacologywill find a wide audience among all prescribing clinicians, psychiatric educators and their students, and other mental health practitioners.

Henry R. Kranzler, M.D., is Professor of Psychiatry, Associate Scientific Director of the Alcohol Research Center, and Assistant Dean for Clinical Research at the University of Connecticut School of Medicine in Farmington, Connecticut.

Domenic A. Ciraulo, M.D., is Psychiatrist-in-Chief, Boston Medical Center, and Professor and Chairman, Division of Psychiatry, Boston University School of Medicine in Boston, Massachusetts.

Contributors

xiii

Preface

xvii

Alcohol

1

(54)

Henry R. Kranzler

Domenic A. Ciraulo

Epidemiology of Drinking, Heavy Drinking, and Alcohol Use Disorders

2

(3)

Pharmacology of Ethanol and Its Relationship to Medications Development

5

(11)

Pharmacokinetics of Alcohol

5

(4)

Pharmacodynamics of Alcohol

9

(7)

Pharmacotherapy of Heavy Drinking and Alcohol Use Disorders

16

(23)

Treatment of Alcohol Withdrawal

17

(2)

Medications to Reduce or Stop Drinking Behavior

19

(20)

Conclusion

39

(2)

References

41

(14)

Opioids

55

(56)

Steven Epstein

John A. Renner Jr.

Domenic A. Ciraulo

Clifford M. Knapp

Jerome H. Jaffe

A Brief History

55

(1)

Prevalence and Natural History

56

(6)

Prevalence and Patterns of Opioid Use and Dependence

56

(3)

Factors Influencing Course and Treatment Outcomes

59

(1)

Medical Complications and Life Expectancy

60

(2)

Pharmacology

62

(4)

Opioid Receptors

63

(1)

Mechanisms of Tolerance and Dependence

64

(2)

Etiology of Opioid Dependence

66

(2)

Clinical Aspects of Tolerance and Withdrawal

68

(3)

Tolerance

68

(1)

Withdrawal

68

(3)

Treatment Approaches

71

(16)

Opioid Detoxification

71

(4)

Agonist Replacement

75

(1)

Opioid Substitution Therapy

75

(8)

Detoxification From Maintenance Treatment

83

(1)

Opioid Antagonists

84

(1)

Therapeutic Communities

85

(1)

Outpatient Drug-Free Treatment and Psychotherapy

86

(1)

Opioid-Associated Problems

87

(6)

Pregnancy and Opioids

87

(2)

Psychiatric Disorders

89

(4)

Conclusion

93

(2)

References

95

(16)

Sedative-Hypnotics

111

(52)

Domenic A. Ciraulo

Jon A. Ciraulo

Brian F. Sands

Clifford M. Knapp

Ofra Sarid-Segal

Benzodiazepines and Selective GABAA1 Agonists

113

(25)

Prevalence of Misuse, Abuse, and Dependence

113

(4)

Prevalence in Special Populations

117

(3)

Overview of Neuropharmacology

120

(5)

Pharmacokinetics

125

(1)

Etiologic Theories of Misuse, Abuse, and Dependence

126

(2)

Clinical Signs and Symptoms of Intoxication and Abstinence Syndrome

128

(2)

Medical and Psychological Consequences of Abuse

130

(1)

Protocols for Detoxification

130

(6)

Role of Psychosocial Therapy

136

(1)

Predictors of Long-Term Discontinuation

136

(1)

Summary of Benzodiazepine Dependence Issues

137

(1)

Barbiturates

138

(8)

Prevalence of Dependence

138

(1)

Pharmacology

138

(3)

Pharmacokinetics

141

(1)

Clinical Uses

142

(1)

Toxicity

142

(1)

Tolerance and Withdrawal

143

(1)

Detoxification

143

(3)

Glutethimide Dependence

146

(1)

Conclusion

147

(1)

References

148

(15)

Cannabis

163

(20)

Michael Lynskey

Scott E. Lukas

Prevalence of Cannabis Dependence

165

(1)

Cannabis Dependence and Withdrawal

166

(5)

Research With Human Subjects

166

(1)

Animal Studies

167

(3)

Summary

170

(1)

Treatments for Cannabis Dependence

171

(4)

Behavioral Treatments

171

(1)

Pharmacological Aids in Cannabis Cessation

171

(4)

Conclusion

175

(1)

References

176

(7)

Cocaine and Psychostimulants

183

(28)

Thomas R. Kosten

Domenic A. Ciraulo

Chemistry and Pharmacology

186

(1)

Neurochemical Actions Mediating Stimulant Reward

187

(1)

Neurobiological Effects of Chronic Stimulant Abuse

188

(2)

Behavioral Effects

190

(2)

Treatment Guidelines for Stimulant Abuse

192

(1)

Specific Pharmacological Treatments for Stimulant Abuse

193

(7)

Pharmacotherapy for Primary Stimulant Dependence

194

(5)

Pharmacotherapy and Psychiatric Comorbidity

199

(1)

Conclusion

200

(1)

References

201

(10)

Hallucinogens and Phencyclidine

211

(32)

Ulrich Tacke

Michael H. Ebert

Tryptamine-Related Hallucinogens (Indolealkylamines)

212

(12)

History and Prevalence of Abuse

213

(3)

Pharmacology

216

(2)

Acute and Chronic Effects

218

(6)

Phenylalkylamine Hallucinogens

224

(7)

History and Prevalence of Abuse of Mescaline (Peyote)

224

(1)

Pharmacology of Mescaline

225

(1)

History, Prevalence of Abuse, and Pharmacology of Hallucinogenic Phenylalkylamine Derivatives

226

(5)

Phencyclidine and Ketamine

231

(3)

History and Prevalence of Abuse

231

(1)

Pharmacology of PCP and Ketamine

232

(1)

Treatment of Intoxication

233

(1)

Anticholinergic Plants and Synthetic Agents

234

(3)

Clinical Findings in Anticholinergic Intoxication

235

(1)

Treatment of Anticholinergic Intoxication

236

(1)

References

237

(6)

Club Drugs

243

(26)

Richard N. Rosenthal

Ramon Solhkhah

GHB and Related Compounds

244

(10)

Epidemiology and Clinical Presentation

244

(2)

Basic and Clinical Pharmacology

246

(4)

Toxicology

250

(2)

Treatment

252

(2)

MDMA (Ecstasy)

254

(4)

Epidemiology and Clinical Presentation

255

(1)

Basic and Clinical Pharmacology

256

(1)

Toxicology

256

(1)

Treatment

257

(1)

Ketamine

258

(2)

Epidemiology and Clinical Presentation

258

(1)

Basic and Clinical Pharmacology

258

(1)

Toxicology

259

(1)

Treatment

259

(1)

Conclusion

260

(1)

References

260

(9)

Inhalants

269

(46)

Carlos Hernandez-Avila

Amira Pierucci-Lagha

Historical Aspects

269

(2)

Epidemiology

271

(1)

Types of Inhalants

272

(2)

Volatile Solvents

272

(1)

Nitrites

272

(1)

Anesthetics

273

(1)

Pharmacokinetics

274

(2)

Volatile Solvents

274

(1)

Nitrites

275

(1)

Anesthetics

275

(1)

Summary

276

(1)

Behavioral Pharmacology of Inhalants in Animals and Humans

276

(4)

Reinforcing Effects

276

(1)

Effects on Motor Activity

277

(1)

Tolerance

278

(1)

Withdrawal

279

(1)

Summary

280

(1)

Effects of Inhalants on Specific Neurotransmitter Systems

280

(5)

Dopaminergic Effects

280

(2)

Glutamate/N-Methyl-D-Aspartate Receptor Effects

282

(1)

Effects on Ligand-Gated Ion Channels

282

(3)

Opioid Receptors

285

(1)

Phenomenology and Variations in the Presentation of Inhalant Use Disorders

285

(9)

Patterns of Inhalant Use in Humans

287

(2)

Phenomenology of Inhalant-Induced Disorders

289

(5)

Clinical Evaluation of Patients With Inhalant Use Disorders

294

(3)

Psychiatric History and Examination

294

(1)

Physical Examination and Laboratory Findings

295

(1)

Neuropsychological Testing

296

(1)

Neurophysiological Testing

297

(1)

Treatment

297

(6)

Psychosocial Treatment

298

(1)

Pharmacotherapy

298

(5)

Conclusion

303

(1)

References

303

(12)

Tobacco

315

(24)

Cheryl A. Oncken

Tony P. George

Phenomenology of Nicotine Addiction and Clinical Aspects of Withdrawal

316

(1)

Pharmacological Treatments for Tobacco Dependence

317

(13)

Nicotine Replacement Therapies

317

(4)

Nonnicotine Pharmacotherapies

321

(9)

Treatment of Special Populations of Smokers

330

(3)

Patients With Comorbid Psychiatric Disorders

330

(2)

Smokers With Comorbid Medical Problems

332

(1)

Pregnant Smokers

332

(1)

Conclusion

333

(1)

References

334

(5)

Psychotherapy and Pharmacotherapy in Treatment of Substance Use Disorders

339

(26)

David M. Ledgerwood

Mary E. McCaul

Nancy M. Petry

Psychotherapies for Substance Use Disorders

340

(10)

Brief Interventions

340

(2)

Motivational Enhancement Therapy

342

(1)

Cognitive-Behavioral Therapies

343

(3)

Behavioral Treatments

346

(1)

Behavioral Couples Therapy

347

(2)

12-Step Therapies

349

(1)

Interactions of Psychotherapy and Pharmacological Treatments

350

(5)

Conclusion

355

(1)

References

356

(9)

Index

365

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"The Clinical Manual of Addiction Psychopharmacology offers a comprehensive, meticulously detailed review of the pharmacology of addictive drugs and the medications used to treat abuse of and dependence on these addictive drugs. Though rich in detailed background, Clinical Manual of Addiction Psychopharmacology is written with a therapeutic focus, as a clinical guide for the use of pharmacotherapy in patients with substance use disorders."--BOOK JACKET.