Concepts of Chemical Dependency

by Doweiko, Harold E.

• ISBN13: 9780534537227
• ISBN10: 0534537227
• Edition: 5th
• Format: Paperback
• Copyright: 2001-07-09
• 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. This text is the most thorough and comprehensive text on the market providing readers with information on substances as well as clinical guidelines and strategies for working with clients. 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

Why Worry about Recreational Chemical Use in the United States?	1	(11)
Introduction	1	(1)
Who ``Treats'' Those Who Abuse or Are Addicted to Chemicals?	2	(1)
The Scope of the Problem of Chemical Abuse and Addiction	3	(4)
The Cost of Chemical Abuse and Addiction in the United States	7	(2)
Summary	9	(2)
What Do We Mean When We Say Substance Abuse and Addiction?	11	(7)
Introduction	11	(1)
The Continuum of Chemical Use	11	(2)
Definitions of Terms to Be Used in This Book	13	(2)
What Do We Really Know about the Addictive Disorders?	15	(1)
The State of the Art: Unanswered Questions, Uncertain Answers	16	(1)
Summary	17	(1)
The Medical Model of Chemical Addiction	18	(12)
Introduction	18	(1)
Why Do People Abuse Chemicals?	18	(3)
What Do We Mean When We Say That Someone Is ``Addicted'' to Chemicals?	21	(8)
Summary	29	(1)
Are People Predestined to Become Addicted to Chemicals?	30	(14)
Introduction	30	(1)
Multiple Models	30	(1)
Reaction Against the Disease Model of Addiction	30	(11)
The Final Common Pathway Theory of Addiction	41	(2)
Summary	43	(1)
Addiction as a Disease of the Human Spirit	44	(11)
Introduction	44	(1)
Diseases of the Mind and Diseases of the Spirit: The Mind-Body Question	45	(1)
The Growth of Addiction: The Circle Narrows	46	(1)
The Circle of Addiction: Addicted Priorities	46	(1)
Some Games of Addiction	47	(1)
Honesty as a Part of the Recovery Process	48	(1)
False Pride: The Disease of the Spirit	49	(2)
Projection, Denial, Rationalization, and Minimization: The Four Musketeers of Addiction	51	(2)
Summary	53	(2)
An Introduction to Pharmacology	55	(14)
Introduction	55	(1)
The Prime Effect and Side Effects of Chemicals	55	(1)
Drug Forms and How Drugs Are Administered	56	(2)
Bioavailability	58	(4)
Key Considerations in Assessing the Effects of Chemicals	62	(3)
Sites and Structures of Special Importance in Pharamacology	65	(3)
Summary	68	(1)
An Introduction to Alcohol	69	(10)
Introduction	69	(1)
A Brief History of Alcohol	69	(1)
How Alcohol Is Produced	70	(1)
Alcohol Today	70	(1)
Scope of the Problem of Alcohol Use	71	(1)
The Pharmacology of Alcohol	71	(2)
The Blood Alcohol Level	73	(1)
Subjective Effects of Alcohol on the Individual	74	(2)
Medical Complications of Alcohol Use in the Average Drinker	76	(2)
Alcohol Use and Accidental Injury or Death	78	(1)
Summary	78	(1)
Chronic Alcohol Abuse and Addiction	79	(16)
Introduction	79	(1)
Scope of the Problem	79	(1)
The ``Typical'' Alcohol-Dependent Person	80	(1)
Alcohol Tolerance, Dependency, and ``Craving'': Signposts of Alcoholism	80	(2)
Complications of Chronic Alcohol Use	82	(12)
Summary	94	(1)
Abuse of and Addiction to the Barbiturates and Barbiturate-like Drugs	95	(10)
Introduction	95	(1)
Early Pharmacological Therapy for Anxiety Disorders and Insomnia	95	(1)
History and Current Medical Uses of the Barbiturates	96	(1)
Pharmacology of the Barbiturates	97	(2)
Subjective Effects of Barbiturates at Normal Dosage Levels	99	(1)
Complications of the Barbiturates at Normal Dosage Levels	99	(2)
Effects of the Barbiturates at Above-normal Dosage Levels	101	(1)
Neuroadaptation to, Tolerance to, and Dependency on the Barbiturates	102	(1)
Barbiturate-like Drugs	103	(1)
Summary	104	(1)
Abuse of and Addiction to Benzodiazepines and Similar Agents	105	(16)
Introduction	105	(1)
Medical Uses of the Benzodiazepines	105	(1)
Pharmacology of the Benzodiazepines	106	(2)
Side Effects of the Benzodiazepines at Normal Dosage Levels	108	(1)
Neuroadaptation to Benzodiazepines, and Their Abuse/Addiction	109	(1)
Complications Caused by Benzodiazepine Use at Normal Dosage Levels	110	(3)
Subjective Experience of Benzodiazepine Use	113	(1)
Long-term Consequences of Chronic Benzodiazepine Use	114	(1)
Buspirone	115	(2)
Zolpidem	117	(1)
Zaleplon	118	(1)
Rohypnol	118	(1)
Summary	119	(2)
Abuse of and Addiction to Amphetamines and CNS Stimulants	121	(15)
Introduction	121	(1)
The CNS Stimulants as Used in Medical Practice	121	(1)
The Amphetamine-like Drugs	121	(3)
The Amphetamines	124	(4)
CNS Stimulant Abuse	128	(1)
Scope of the Problem of Stimulant Abuse and Addiction	128	(1)
Effects of the CNS Stimulants When Abused	128	(7)
Summary	135	(1)
Cocaine	136	(15)
Introduction	136	(1)
A Brief Overview of Cocaine	136	(1)
Cocaine in Recent U.S. History	137	(1)
Cocaine Today	138	(2)
Pharmacology of Cocaine	140	(1)
How Illicit Cocaine Is Produced	141	(1)
How Cocaine Is Abused	142	(2)
Subjective Effects of Cocaine When It Is Abused	144	(1)
Complications of Cocaine Abuse/Addiction	145	(4)
Summary	149	(2)
Marijuana Abuse and Addiction	151	(11)
Introduction	151	(1)
History of Marijuana Use in the United States	151	(2)
The Potency of Marijuana Currently Being Used	153	(1)
Scope of the Problem of Marijuana Abuse	153	(1)
Pharmacology of Marijuana	154	(1)
Methods of Administration	155	(1)
Subjective Effects of Marijuana	156	(1)
Adverse Effects of Occasional Marijuana Use	157	(1)
Consequences of Chronic Marijuana Abuse	158	(2)
The Addiction Potential of Marijuana	160	(1)
Summary	160	(2)
Opiate Abuse and Addiction	162	(21)
Introduction	162	(1)
The Medical Uses of Narcotic Analgesics	162	(1)
A Short History of the Narcotic Analgesics	162	(2)
The Classification of Analgesics	164	(1)
Where Opium Is Produced	164	(1)
Current Medical Uses of the Narcotic Analgesics	165	(1)
Pharmacology of the Narcotic Analgesics	165	(3)
Subjective Effects of Narcotic Analgesics When Used in Medical Practice	168	(1)
Complications Caused by Narcotic Analgesics When Used in Medical Practice	169	(2)
Fentanyl	171	(1)
Buprenorphine	172	(2)
Opiates As Drugs of Abuse	172	(2)
Methods of Opiate Abuse	174	(2)
Scope of the Problem of Opiate Abuse and Addiction in the United States	176	(4)
Complications Caused by Chronic Opiate Abuse	180	(1)
Opiate Overdose	181	(1)
Summary	182	(1)
Hallucinogen Abuse and Addiction	183	(15)
Introduction	183	(1)
History of Hallucinogens in the United States	183	(1)
Scope of the Problem	184	(1)
Pharmacology of the Hallucinogens	184	(2)
Subjective Effects of Hallucinogens	186	(3)
Phencyclidine (PCP)	189	(2)
Complications of PCP Abuse	191	(1)
Ecstasy: Evolution of a New Drug of Abuse	192	(5)
Summary	197	(1)
Abuse of and Addiction to the Inhalants and Aerosols	198	(8)
Introduction	198	(1)
The History of Inhalant Abuse	198	(1)
The Pharmacology of the Inhalants	199	(1)
Scope of the Problem	200	(1)
Method of Administration	201	(1)
Subjective Effects of Inhalants	202	(1)
Complications from Inhalants Abuses	202	(2)
Misuse of Anesthetics	204	(1)
Abuse of Nitrites	205	(1)
Summary	205	(1)
The Unrecognized Problem of Steroid Abuse and Addiction	206	(8)
Introduction	206	(1)
An Introduction to the Anabolic Steroids	206	(1)
Medical Uses of Anabolic Steroids	207	(1)
The Legal Status of Anabolic Steroids	207	(1)
Scope of the Problem of Steroid Abuse	207	(1)
Sources and Methods of Steroid Abuse	207	(2)
Problems Associated with Anabolic Steroid Abuse	209	(1)
Complications of Steroid Abuse	209	(3)
Are Anabolic Steroids Addictive?	212	(1)
Summary	213	(1)
The Over-the-Counter Analgesics: Unexpected Agents of Abuse	214	(15)
Introduction	214	(1)
A Short History of the OTC Analgesics	214	(1)
Medical Uses of the OTC Analgesics	215	(2)
Pharmacology of the OTC Analgesics	217	(2)
Normal Dosage Levels of OTC Analgesics	219	(2)
Complications Caused by the Use of OTC Analgesics	221	(4)
Overdose of OTC Analgesics	225	(2)
Summary	227	(2)
Tobacco Products and Nicotine Addiction	229	(14)
Introduction	229	(1)
History of Tobacco Use in the United States	229	(1)
Scope of the Problem	230	(1)
Pharmacology of Cigarette Smoking	231	(3)
Subjective Effects of Nicotine Use	234	(1)
Nicotine Addiction	235	(2)
Complications of the Chronic Use of Tobacco	237	(5)
Summary	242	(1)
Chemicals and the Neonate: The Consequences of Drug Abuse During Pregnancy	243	(14)
Introduction	243	(1)
Scope of the Problem	243	(13)
Summary	256	(1)
The Hidden Faces of Chemical Dependency	257	(14)
Introduction	257	(1)
Women and Addiction: An Often Unrecognized Problem	257	(5)
Addiction and the Homeless	262	(1)
Substance Use Problems and the Elderly	262	(4)
The Homosexual and Substance Abuse	266	(2)
Substance Abuse and the Disabled	268	(1)
Substance Abuse and Ethnic Minorities	268	(2)
Summary	270	(1)
The Dual-Diagnosis Client: Chemical Addiction and Mental Illness	271	(12)
Introduction	271	(1)
Definitions	271	(1)
Dual-Diagnosis Clients: A Diagnostic Challenge	271	(1)
Why Worry About the Dual-Diagnosis Client?	272	(1)
The Scope of the Problem	273	(1)
Characteristics of Dual-Problem Clients	274	(4)
Problems in Working with Dual-Diagnosis Clients	278	(1)
Treatment Approaches	279	(3)
Summary	282	(1)
Chemical Abuse by Children and Adolescents	283	(16)
Introduction	283	(1)
The Importance of Childhood and Adolescence in the Evolution of Substance Use Problems	283	(1)
Scope of the Problem	284	(5)
Why Do Adolescents Use Chemicals?	289	(2)
The Adolescent Abuse/Addiction Dilemma: How Much Is Too Much?	291	(4)
Possible Diagnostic Criteria for Adolescent Drug/Alcohol Problems	295	(2)
The Special Needs of the Adolescent in a Substance Abuse Rehabilitation Program	297	(1)
Summary	298	(1)
Codependency and Enabling	299	(10)
Introduction	299	(1)
Enabling	299	(2)
Codependency	301	(3)
Reactions to the Concept of Codependency	304	(4)
Summary	308	(1)
Addiction and the Family	309	(10)
Introduction	309	(1)
Scope of the Problem	309	(1)
Addiction and Marriage	309	(2)
Addiction and the Family	311	(2)
The Adult Children of Alcoholics (ACOA) Movement	313	(5)
Summary	318	(1)
The Evaluation of Substance Abuse Problems	319	(15)
Introduction	319	(1)
The Theory Behind Alcohol and Drug Use Evaluations	319	(1)
Screening	320	(2)
Assessment	322	(1)
Diagnosis	323	(1)
The Assessor and Data Privacy	324	(1)
Diagnostic Rules	325	(1)
The Assessment Format	326	(4)
Other Sources of Information	330	(1)
The Outcome of the Evaluation Process	331	(1)
Summary	331	(3)
The Process of Intervention	334	(8)
Introduction	334	(1)
A Definition of Intervention	334	(1)
Characteristics of the Intervention Process	335	(1)
The Mechanics of Intervention	335	(3)
Intervention with Other Forms of Chemical Addiction	338	(1)
The Ethics of Intervention	338	(1)
Intervention via the Court System	339	(1)
Other Forms of Intervention	340	(1)
Summary	341	(1)
The Treatment of Chemical Dependency	342	(10)
Introduction	342	(1)
The Substance Abuse Rehabilitation Professional	342	(2)
The Minnesota Model of Chemical Dependency Treatment	344	(2)
The Treatment Plan	346	(1)
Other Treatment Formats for Chemical Dependency	347	(4)
Aftercare Programs	351	(1)
Summary	351	(1)
Treatment Formats for Chemical Dependency Rehabilitation	352	(12)
Introduction	352	(1)
Outpatient Treatment	352	(3)
Inpatient Treatment	355	(2)
Is There a Legitimate Need for Inpatient Treatment?	357	(2)
Inpatient or Outpatient Treatment?	359	(3)
Summary	362	(2)
The Process of Recovery	364	(10)
Introduction	364	(1)
The Stages of Recovery	364	(5)
Specific Points to Address with Common Drugs of Abuse	369	(4)
Summary	373	(1)
Problems That Can Arise in Treating Chemical Dependency	374	(15)
Introduction	374	(1)
Limit Testing by Clients in Treatment	374	(1)
Treatment Noncompliance	375	(1)
Relapse and Relapse Prevention	376	(2)
``Cravings'' and ``Urges''	378	(2)
Controlled Drinking	380	(1)
Clients Who Appear for Their Appointment While Under the Influence of Chemicals	380	(1)
Toxicology Testing as a Measure of Treatment Compliance and Drug Use	381	(5)
Insurance Reimbursement Policies	386	(2)
Summary	388	(1)
Pharmacological Intervention Tactics and Substance Abuse	389	(15)
Introduction	389	(1)
Pharmacological Treatment of Alcohol Abuse and Dependency	389	(5)
Pharmacological Treatment of Opiate Addiction	394	(4)
Pharmacological Treatment of Cocaine Addiction	398	(2)
Pharmacological Treatment of Nicotine Dependency	400	(3)
Summary	403	(1)
Substance Abuse/Addiction and Infectious Disease	404	(14)
Introduction	404	(1)
Why Is Infectious Disease Such a Common Complication of Alcohol/Drug Abuse?	404	(1)
The Pneumonias	405	(1)
Acquired Immune Deficiency Syndrome (AIDS)	406	(6)
Tuberculosis (TB)	412	(1)
Viral Hepatitis	413	(4)
Summary	417	(1)
Self-Help Groups	418	(15)
The Twelve Steps of Alcoholics Anonymous	418	(1)
Introduction	418	(1)
The History of AA	419	(1)
Elements of AA	419	(2)
AA and Religion	421	(1)
One ``A'' Is for Anonymous	422	(1)
AA and Outside Organizations	422	(1)
The Primary Purpose of AA	423	(1)
Of AA and Recovery	424	(1)
Sponsorship	425	(1)
AA and Psychological Theory	425	(1)
How Does AA Work?	425	(1)
Outcome Studies: The Effectiveness of AA	426	(2)
Narcotics Anonymous	428	(1)
Al-Anon and Alateen	428	(1)
Support Groups Other Than AA	429	(2)
Criticism of the AA/Twelve-Step Movement	431	(1)
Summary	432	(1)
Crime and Drug Use	433	(15)
Introduction	433	(1)
Drug Abuse and Criminal Behavior	433	(1)
The ``War on Drugs'': The Making of a National Disaster	434	(7)
Drug Use and Violence: The Unseen Connection	441	(1)
Unseen Victims of Street-Drug Chemistry	441	(2)
Drug Analogues: The ``Designer'' Drugs	443	(4)
Summary	447	(1)
Appendix 1 Sample Assessment: Alcohol Abuse Situation	448	(3)
Appendix 2 Sample Assessment: Chemical Dependency Situation	451	(4)
Appendix 3 The ``Jellinek'' Chart for Alcoholism	455	(1)
Appendix 4 Drug Classification Schedules	456	(2)
Glossary	458	(7)
References	465	(54)
Index	519