Clinical Manual for Treatment of Alcoholism and Addictions

by Mack, Avram H., M.D.

• ISBN13: 9781585623730
• ISBN10: 1585623733
• Edition: 1st
• Format: Paperback
• Copyright: 2010-01-01
• Publisher: AMERICAN PSYCHIATRIC PUBLISHING INC

Summary

This manual is designed to be a guide for all category of health care providers. It contains useful tools for the choices and options of treatment employed by medical professionals. The manual offers an overview of addiction treatment issues; it is relevant to the clinician in the trenches and is a distillation of experienced clinicians in the field of substance abuse.

Author Biography

Avram H. Mack, M.D., is Attending Physician at Georgetown University Hospital, Washington, D.C., and Associate Professor of Clinical Psychiatry at Georgetown University School of Medicine in Washington, D.C.

Amy L. Harrington, M.D., is Physician at Georgetown University Hospital in Washington, D.C.

Richard J. Frances, M.D., is Clinical Professor of Psychiatry at New York University, New York City; Adjunct Professor of Psychiatry at University of Medicine and Dentistry of New Jersey, Newark, New Jersey; and Director of Professional and Public Education at Silver Hill Hospital in New Canaan, Connecticut.

Table of Contents

Foreword	p. xi
Preface	p. xv
Introduction	p. 1
Treatment of Substance Use Disorders: General Tenets	p. 3
Therapeutic Alliance	p. 5
Potential Abuses in the Treatment of Substance Use Disorders	p. 7
Key Points	p. 8
References	p. 8
Magnitude of the Problem	p. 11
General Epidemiology	p. 11
Substances of Abuse and Misuse	p. 14
Underlying Issues Affecting Addiction Magnitude	p. 24
Factors Contributing to Complications	p. 25
Key Points	p. 27
References	p. 28
Neurobiology of Addictive Disorders and the Disease Concept	p. 31
Nosology	p. 33
Neurobiology of the Addictions: Clinical Implications of Research Findings	p. 33
Key Points	p. 40
References	p. 40
Evaluation and Assessment	p. 43
A Moving Target	p. 43
Admission Workup	p. 44
Specific Substance Use History-Taking	p. 44
Diagnostic Instruments	p. 46
Laboratory Evaluations	p. 52
Imaging Studies	p. 60
Key Points	p. 61
References	p. 61
Definition, Presentation, and Diagnosis	p. 63
Nosology	p. 63
DSM-IV Context	p. 64
Generic Definitions and Diagnosis	p. 64
Alcohol	p. 69
Sedatives, Hypnotics, and Anxiolytics	p. 74
Opioids	p. 76
Cocaine	p. 77
Amphetamines	p. 81
Phencyclidine and Ketamine	p. 82
Hallucinogens	p. 83
Cannabis	p. 85
Nicotine	p. 87
Inhalants	p. 89
Caffeine	p. 90
Other (or Unknown) Substance-Related Disorders	p. 91
Polysubstance Dependence	p. 91
Establishing a Diagnosis: Dilemmas, Signs, and Countertransference	p. 92
Psychiatric Comorbidity	p. 94
Key Points	p. 98
References	p. 98
Natural Histories of Substance Abuse	p. 101
Alcohol	p. 101
Sedatives, Hypnotics, and Anxiolytics	p. 105
Opioids	p. 106
Cocaine	p. 108
Amphetamines	p. 110
Phencyclidine and Ketamine	p. 111
Hallucinogens	p. 111
Cannabis	p. 112
Nicotine	p. 114
Inhalants	p. 116
Key Points	p. 117
References	p. 117
Violence and Suicide, Injury, Corrections, and Forensics	p. 121
Violence and Crime	p. 121
Suicide	p. 122
Unintentional Injury	p. 126
Correctional Settings	p. 127
Forensic Practice	p. 129
Key Points	p. 132
References	p. 132
Behavioral Addictions	p. 135
Basis of Overlap Among Addictions	p. 136
Epidemiology	p. 136
Etiology and Neurobiology	p. 137
Pathological Gambling	p. 137
Kleptomania	p. 139
Compulsive Buying	p. 140
Key Points	p. 141
References	p. 141
Children and Adolescents	p. 145
Extent of the Problem	p. 146
Early Detection in Adolescents	p. 146
Contributing Factors	p. 146
Role of Families in Treatment	p. 147
Residential Treatment	p. 148
Substance Intoxication or Psychosis	p. 148
Mentally III, Chemically Abusing Adolescents	p. 149
Assessment	p. 150
Clinical Management Issues	p. 150
Psychopharmacology	p. 151
Relapse Prevention	p. 151
Primary, Secondary, and Tertiary Prevention	p. 152
Neurodevelopmental Effects of Maternal Substance Use on the Fetus	p. 153
Key Points	p. 155
References	p. 156
Specific Populations	p. 159
Women	p. 159
The Elderly	p. 164
Chronic, Disabled, and Homeless Patients	p. 166
Minority Populations	p. 170
Key Points	p. 172
References	p. 172
General Hospital and Primary Care Settings	p. 175
The General Hospital	p. 175
The Outpatient Medical Setting	p. 176
Psychiatric Consultation to General Floors and the Emergency Department	p. 176
Treatment Planning	p. 178
Additional Treatment Issues	p. 178
Making the Referral to Specialty Care	p. 179
Issues in the Care of the Medical/Surgical Patient With a Substance Use Disorder	p. 179
Key Points	p. 184
References	p. 184
Treatment Modalities	p. 185
Psychosocial Modalities	p. 185
Pharmacological Modalities	p. 193
Key Points	p. 204
References	p. 204
Treatment Approaches	p. 209
Abstinence	p. 209
Recovery	p. 210
Relapse	p. 210
Predictors of Successful Treatment Outcome	p. 212
Differential Therapeutics	p. 213
Matching Treatments to Patients	p. 213
Treatment Settings	p. 214
Clinical Situations	p. 216
Withdrawal and Detoxification	p. 222
Special Issues in Treatment	p. 237
Key Points	p. 241
References	p. 241
Public Health Issues	p. 245
The Workplace	p. 245
Public Policy on Prevention and Control	p. 253
Public Sector Clinical Approaches	p. 255
Key Points	p. 258
References	p. 258
Appendix: Workplace Substance Abuse Resources	p. 261
Index	p. 263
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