Concepts of Chemical Dependency

by DOWEIKO

• ISBN13: 9780534357559
• ISBN10: 0534357555
• Edition: 4th
• Format: Paperback
• Copyright: 1998-07-03
• Publisher: Brooks Cole

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.

Table of Contents

1 Recreational Chemical Use in the United States	1	(10)
Who "Treats" Those Who Are Addicted to Chemicals?	2	(1)
The Scope of the Problem of Chemical Abuse and Addiction	3	(5)
The Cost of Chemical Abuse and Addiction in the United States	8	(2)
Why Is It So Difficult to Understand the Drug Abuse Problem in the United States?	10	(1)
Summary	10	(1)
2 Substance Abuse and Addiction	11	(8)
The Continuum of Chemical Use	11	(2)
Definitions of Terms Used in This Book	13	(2)
The Growth of New "Addictions"	15	(1)
What Do We Really Know about the Addictive Disorders?	15	(1)
The State of the Art: Unanswered Questions, Uncertain Answers	16	(2)
Summary	18	(1)
3 An Introduction to Pharmacology	19	(15)
Drug Forms and How Drugs Are Administered	20	(2)
Bioavailability	22	(5)
The Drug Half-Life	27	(1)
The Effective Dose	28	(1)
The Lethal Dose Index	28	(1)
The Therapeutic Index	28	(1)
Peak Effects	29	(1)
The Site of Action	29	(1)
Receptor Sites	30	(2)
The Blood-Brain Barrier	32	(1)
Summary	33	(1)
4 An Introduction to Alcohol	34	(12)
A Brief History of Alcohol	34	(1)
How Alcohol Is Produced	35	(1)
Alcohol Today	36	(1)
Scope of the Problem of Alcohol Use	36	(1)
The Pharmacology of Alcohol	36	(2)
The Biotransformation of Alcohol	38	(1)
The Blood Alcohol Level	39	(1)
Subjective Effects of Alcohol	40	(1)
Effects of Intoxicating Doses of Alcohol for the Average Drinker	41	(1)
Medical Complications of Alcohol Use in the Average Drinker	42	(3)
Alcohol Use and Accidental Injury or Death	45	(1)
Summary	45	(1)
5 Chronic Alcohol	46	(19)
Scope of the Problem	46	(1)
The "Typical" Alcohol-Dependent Person	47	(1)
Alcohol Tolerance, Dependence, and Craving: Signposts of Addiction	47	(2)
Complications of Chronic Alcohol Use	49	(15)
Summary	64	(1)
6 Barbiturates and Barbituratelike Drugs	65	(11)
Early Pharmacological Therapy of Anxiety Disorders and Insomnia	65	(1)
History and Current Medical Uses of the Barbiturates	66	(1)
The Pharmacology of Barbiturates	67	(2)
Subjective Effects of Barbiturates at Normal Dosage Levels	69	(1)
Complications of the Barbiturates at Normal Dosage Levels	69	(2)
Effects of the Barbiturates at Above-Normal Dosage Levels	71	(1)
Tolerance of and Dependence on Barbiturates	72	(1)
Barbituratelike Drugs	73	(2)
Summary	75	(1)
7 Benzodiazepines and Similar Agents	76	(17)
Medical Uses of the Benzodiazepines	76	(1)
Pharmacology of the Benzodiazepines	77	(3)
Benzodiazepine Tolerance, Abuse, and Addiction	80	(2)
Complications Caused by Benzodiazepine Use at Normal Dosage Levels	82	(3)
Subjective Experience of Benzodiazepine Use	85	(1)
Long-Term Consequences of Chronic Benzodiazepine Use	86	(2)
Buspirone: The First Decade	88	(2)
Zolpidem	90	(1)
Rohypnol: A New Drug of Abuse	91	(1)
Summary	92	(1)
8 Amphetamines and Central Nervous System Stimulants	93	(13)
The Amphetaminelike Drugs	93	(1)
The Amphetamines	94	(2)
Scope of the Problem of Stimulant Abuse and Addiction	96	(1)
Medical Uses of Amphetamines and CNS Stimulants	96	(1)
Pharmacology of the Amphetamines	97	(2)
Methods of Amphetamine Abuse	99	(1)
Subjective Experience of Amphetamine Use	99	(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