Concepts of Chemical Dependency

by Doweiko, Harold E.

• ISBN13: 9780534632847
• ISBN10: 053463284X
• Edition: 6th
• Format: Paperback
• Copyright: 2005-07-06
• Publisher: Brooks Cole

Summary

1. Why Worry About Recreational Chemical Use in the United States? 2. What Do We Mean When We Say Substance Abuse and Addiction? 3. The Medical Model of Chemical Addiction. 4. Are People Predestined to Become Addicted to Chemicals? 5. Addiction as a Disease of the Human Spirit. 6. An Introduction to Pharmacology. 7. An Introduction to Alcohol. 8. Chronic Alcohol Abuse/Addiction. 9. Abuse of and Addiction to the Barbiturates and Barbiturate-Like Drugs. 10. Abuse & Addiction to Benzodiazepines and Similar Agents. 11. Abuse and Addiction to Amphetamines and CNS Stimulants. 12. Cocaine. 13. Marijuana Abuse & Addiction. 14. Opiate Abuse & Addiction. 15. Hallucinogen Abuse & Addiction. 16. Abuse of and Addiction to the Inhalants and Aerosols. 17. The Unrecognized Problem of Steroid Abuse and Addiction. 18. The Over-the-Counter Analgesics. 19. Tobacco Products and Nicotine Addiction. 20. Chemicals and the Neonate: The Consequences of Drug Abuse During Pregnancy. 21. The Hidden Faces of Chemical Dependency. 22. The Dual Diagnosis Client: Chemical Addiction and Mental Illness. 23. Chemical Abuse by Children and Adolescents. 24. Codependency and Enabling. 25. Addiction and the Family. 26. The Evaluation of Substance Abuse Problems. 27. The Process of Intervention. 28. The Treatment of Chemical Dependency. 29. Treatment Formats for Chemical Dependency Rehabilitation. 30. The Process of Recovery. 31. Problems That Arise in Treating Chemical Dependency. 32. Pharmacological Intervention Tactics and Substance Abuse. 33. Substance Abuse/Addiction and Infectious Disease. 34. Self Help Groups. 35. Crime and Drug Use. Appendices. Glossary. References.

Table of Contents

Preface	xix
Why Worry About Recreational Chemical Abuse?	1	(8)
Introduction	1	(1)
Who Treats Those Who Abuse or Are Addicted to Chemicals?	2	(1)
The Scope of the Problem of Chemical Abuse/Addiction	3	(2)
The Cost of Chemical Abuse/Addiction in the United States	5	(2)
Why Is It So Difficult to Understand the Drug Abuse Problem in the United States?	7	(1)
Summary	7	(2)
What Do We Mean When We Say Substance Abuse and Addiction?	9	(7)
Introduction	9	(1)
The Continuum of Chemical Use	9	(2)
Definitions of Terms Used in This Book	11	(1)
What Do We Really Know About the Addictive Disorders?	12	(1)
The State of the Art: Unanswered Questions, Uncertain Answers	13	(2)
Summary	15	(1)
The Medical Model of Chemical Addiction	16	(13)
Introduction	16	(1)
Why Do People Abuse Chemicals?	16	(4)
What Do We Mean When We Say That Someone Is ``Addicted'' to Chemicals?	20	(8)
Summary	28	(1)
Are People Predestined to Become Addicted to Chemicals?	29	(15)
Introduction	29	(1)
Multiple Models	29	(1)
Reaction Against the Disease Model of Addiction	29	(12)
The Final Common Pathway Theory of Addiction	41	(1)
Summary	42	(2)
Addiction as a Disease of the Human Spirit	44	(11)
Introduction	44	(1)
The Rise of Western Civilization, or How the Spirit Was Lost	44	(2)
Diseases of the Mind---Diseases of the Spirit: The Mind-Body Question	46	(1)
The Growth of Addiction: The Circle Narrows	46	(1)
The Circle of Addiction: Addicted Priorities	47	(1)
Some Games of Addiction	48	(1)
Honesty as a Part of the Recovery Process	49	(1)
False Pride: The Disease of the Spirit	50	(2)
Denial, Rationalization, Projection, and Minimization: The Four Horsemen of Addiction	52	(2)
Summary	54	(1)
An Introduction to Pharmacology	55	(15)
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)
The Drug Half-Life	62	(2)
The Effective Dose	64	(1)
The Lethal Dose Index	64	(1)
The Therapeutic Index	64	(1)
Peak Effects	65	(1)
The Site of Action	65	(4)
The Blood-Brain Barrier	69	(1)
Summary	69	(1)
Alcohol: Humans' Oldest Recreational Chemical	70	(12)
Introduction	70	(1)
A Brief History of Alcohol	70	(1)
How Alcohol Is Produced	71	(1)
Alcohol Today	72	(1)
Scope of the Problem of Alcohol Use	72	(1)
Pharmacology of Alcohol	73	(2)
The Blood Alcohol Level	75	(1)
Subjective Effects of Alcohol on the Individual: At Normal Doses in the Average Drinker	76	(1)
Effects of Alcohol at Intoxicating Doses: For the Average Drinker	77	(1)
Medical Complications of Alcohol Use in the Average Drinker	78	(2)
Alcohol Use and Accidental Injury or Death	80	(1)
Summary	81	(1)
Chronic Alcohol Abuse and Addiction	82	(18)
Introduction	82	(1)
Scope of the Problem	82	(1)
Is There a ``Typical'' Alcohol-Dependent Person?	83	(1)
Alcohol Tolerance, Dependence, and ``Craving'': Signposts of Alcoholism	83	(2)
Complications of Chronic Alcohol Use	85	(14)
Summary	99	(1)
Abuse and Addiction to the Barbiturates and Barbiturate-like Drugs	100	(12)
Introduction	100	(1)
Early Pharmacological Therapy of Anxiety Disorders and Insomnia	100	(1)
History and Current Medical Uses of the Barbiturates	101	(1)
Pharmacology of the Barbiturates	102	(2)
Subjective Effects of the Barbiturates at Normal Dosage Levels	104	(1)
Complications of the Barbiturates at Normal Dosage Levels	105	(2)
Effects of the Barbiturates at Above-Normal Levels	107	(1)
Neuroadaptation, Tolerance to, and Dependence on the Barbiturates	108	(1)
Barbiturate-like Drugs	109	(1)
Summary	110	(2)
Abuse of and Addiction to Benzodiazepines and Similar Agents	112	(16)
Introduction	112	(1)
Medical Uses of the Benzodiazepines	112	(2)
Pharmacology of the Benzodiazepines	114	(1)
Side Effects of the Benzodiazepines When Used at Normal Dosage Levels	115	(1)
Neuroadaptation to Benzodiazepines and Abuse/Addiction to These Agents	116	(2)
Complications Caused by Benzodiazepine Use at Normal Dosage Levels	118	(2)
Subjective Experience of Benzodiazepine Use	120	(1)
Long-Term Consequences of Chronic Benzodiazepine Use	121	(1)
Buspirone	122	(2)
Zolpidem	124	(1)
Zaleplon	125	(1)
Rohypnol	126	(1)
Summary	127	(1)
Abuse of and Addiction to Amphetamines and CNS Stimulants	128	(18)
Introduction	128	(1)
The CNS Stimulants as Used in Medical Practice	128	(1)
The Amphetamine-like Drugs	128	(4)
The Amphetamines	132	(4)
CNS Stimulant Abuse	136	(1)
Scope of the Problem of CNS Stimulant Abuse and Addiction	136	(1)
Effects of the CNS Stimulants When Abused	136	(8)
Summary	144	(2)
Cocaine	146	(15)
Introduction	146	(1)
A Brief Overview of Cocaine	146	(1)
Cocaine in Recent U.S. History	147	(1)
Cocaine Today	148	(1)
Pharmacology of Cocaine	149	(2)
How Illicit Cocaine Is Produced	151	(1)
How Cocaine Is Abused	152	(2)
Subjective Effects of Cocaine When It Is Abused	154	(1)
Complications of Cocaine Abuse/Addiction	155	(4)
Summary	159	(2)
Marijuana Abuse and Addiction	161	(13)
Introduction	161	(1)
History of Marijuana Use in the United States	161	(2)
A Question of Potency	163	(1)
A Technical Point	163	(1)
Scope of the Problem of Marijuana Abuse	164	(1)
Pharmacology of Marijuana	165	(2)
Methods of Administration	167	(1)
Subjective Effects of Marijuana	168	(1)
Adverse Effects of Occasional Marijuana Use	168	(1)
Consequences of Chronic Marijuana Abuse	169	(3)
The Addiction Potential of Marijuana	172	(1)
Summary	172	(2)
Opiate Abuse and Addiction	174	(23)
Introduction	174	(1)
The Medical Uses of Narcotic Analgesics	174	(1)
A Short History of the Narcotic Analgesics	174	(2)
The Classification of Narcotic Analgesics	176	(1)
Where Opium Is Produced	177	(1)
Current Medical Uses of the Narcotic Analgesics	177	(1)
Pharmacology of the Narcotic Analgesics	177	(3)
Neuroadaptation to Narcotic Analgesics	180	(2)
Subjective Effects of Narcotic Analgesics When Used in Medical Practice	182	(1)
Complications Caused by Narcotic Analgesics When Used in Medical Practice	182	(2)
Fentanyl	184	(1)
Buprenorphine	185	(1)
Opiates As Drugs of Abuse	186	(1)
The Mystique of Heroin	186	(2)
Other Narcotic Analgesics That Might Be Abused	188	(1)
Methods of Opiate Abuse	189	(2)
Scope of the Problem of Opiate Abuse and Addiction	191	(1)
Complications Caused by Chronic Opiate Abuse	192	(3)
Overdose of Illicit Opiates	195	(1)
Summary	196	(1)
Hallucinogen Abuse and Addiction	197	(16)
Introduction	197	(1)
History of Hallucinogens in the United States	197	(2)
Scope of the Problem	199	(1)
Pharmacology of the Hallucinogens	199	(2)
Subjective Effects of Hallucinogens	201	(2)
Phencyclidine (PCP)	203	(4)
Ecstasy: Evolution of a New Drug of Abuse	207	(5)
Summary	212	(1)
Abuse of and Addiction to the Inhalants and Aerosols	213	(8)
Introduction	213	(1)
History of Inhalant Abuse	213	(1)
Pharmacology of the Inhalants	214	(1)
Scope of the Problem	215	(1)
Method of Administration	216	(1)
Subjective Effects of Inhalants	216	(1)
Complications From Inhalant Abuse	217	(1)
Anesthetic Misuse	218	(1)
Abuse of Nitrites	219	(1)
Summary	220	(1)
The Unrecognized Problem of Steroid Abuse and Addiction	221	(8)
Introduction	221	(1)
An Introduction to the Anabolic Steroids	221	(1)
Medical Uses of Anabolic Steroids	222	(1)
The Legal Status of Anabolic Steroids	222	(1)
Scope of the Problem of Steroid Abuse	222	(1)
Sources and Methods of Steroid Abuse	222	(1)
Problems Associated With Anabolic Steroid Abuse	223	(2)
Complications of Steroid Abuse	225	(2)
Are Anabolic Steroids Addictive?	227	(1)
Summary	228	(1)
The Over-the-Counter Analgesics: Unexpected Agents of Abuse	229	(16)
Introduction	229	(1)
A Short History of the OTC Analgesics	229	(1)
Medical Uses of the OTC Analgesics	230	(2)
Pharmacology of the OTC Analgesics	232	(3)
Normal Dosage Levels of OTC Analgesics	235	(2)
Complications Caused by Use of OTC Analgesics	237	(4)
Overdose of OTC Analgesics	241	(2)
Summary	243	(2)
Tobacco Products and Nicotine Addiction	245	(15)
Introduction	245	(1)
History of Tobacco Use in the United States	245	(1)
Scope of the Problem	246	(1)
Pharmacology of Cigarette Smoking	247	(3)
The Effects of Nicotine Use	250	(1)
Nicotine Addiction	251	(1)
Complications of the Chronic Use of Tobacco	252	(7)
Summary	259	(1)
Chemicals and the Neonate: The Consequences of Drug Abuse During Pregnancy	260	(15)
Introduction	260	(1)
Scope of the Problem	260	(1)
The Fetal Alcohol Spectrum Disorder	261	(2)
Cocaine Use During Pregnancy	263	(3)
Amphetamine Use During Pregnancy	266	(1)
Opiate Abuse During Pregnancy	266	(2)
Marijuana Use During Pregnancy	268	(1)
Benzodiazepine Use During Pregnancy	269	(1)
Hallucinogen Use During Pregnancy	270	(1)
Buspirone Use During Pregnancy	270	(1)
Bupropion Use During Pregnancy	270	(1)
Disulfiram Use During Pregnancy	271	(1)
Cigarette Use During Pregnancy	271	(1)
Over-the-Counter Analgesic Use During Pregnancy	272	(1)
Inhalant Abuse During Pregnancy	273	(1)
Summary	273	(2)
Hidden Faces of Chemical Dependency	275	(15)
Introduction	275	(1)
Women and Addiction: An Often Unrecognized Problem	275	(5)
Addiction and the Homeless	280	(1)
Substance Use Problems and the Elderly	280	(4)
The Homosexual and Substance Abuse	284	(2)
Substance Abuse and the Disabled	286	(1)
Substance Abuse and Ethnic Minorities	287	(2)
Summary	289	(1)
The Dual-Diagnosis Client: Chemical Addiction and Mental Illness	290	(14)
Introduction	290	(1)
Definitions	290	(1)
Dual-Diagnosis Clients: A Diagnostic Challenge	291	(1)
Why Worry About the Dual-Diagnosis Client?	291	(1)
The Scope of the Problem	292	(1)
Characteristics of Dual-Diagnosis Clients	293	(1)
Psychopathology and Drug of Choice	293	(6)
Problems in Working With Dual-Diagnosis Clients	299	(1)
Treatment Approaches	300	(3)
Summary	303	(1)
Chemical Abuse by Children and Adolescents	304	(16)
Introduction	304	(1)
The Importance of Childhood and Adolescence in the Evolution of Substance-Use Problems	304	(1)
Scope of the Problem	305	(5)
Why Do Adolescents Use Chemicals?	310	(3)
The Adolescent Abuse/Addiction Dilemma: How Much Is Too Much?	313	(4)
Possible Diagnostic Criteria for Adolescent Drug/Alcohol Problems	317	(1)
The Special Needs of the Adolescent in a Substance-Abuse Rehabilitation Program	318	(1)
Summary	319	(1)
Codependency and Enabling	320	(10)
Introduction	320	(1)
Enabling	320	(1)
Codependency	321	(5)
Reactions to the Concept of Codependency	326	(3)
Summary	329	(1)
Addiction and the Family	330	(11)
Introduction	330	(1)
Scope of the Problem	330	(1)
Addiction and Marriage	330	(2)
Addiction and the Family	332	(3)
The Adult Children of Alcoholics (ACOA) Movement	335	(4)
Summary	339	(2)
The Evaluation of Substance-Use Problems	341	(15)
Introduction	341	(1)
The Theory Behind Alcohol- and Drug-Use Evaluations	341	(1)
Screening	342	(2)
Assessment	344	(1)
Diagnosis	345	(1)
The Assessor and Data Privacy	346	(1)
Diagnostic Rules	347	(1)
The Assessment Format	348	(4)
Other Sources of Information	352	(3)
The Outcome of the Evaluation Process	355	(1)
Summary	355	(1)
The Process of Intervention	356	(9)
Introduction	356	(1)
A Definition of Intervention	356	(1)
Characteristics of the Intervention Process	357	(1)
The Mechanics of Intervention	357	(1)
Family Intervention	358	(2)
Intervention With Other Forms of Chemical Addiction	360	(1)
The Ethics of Intervention	361	(1)
Intervention via the Court System	362	(2)
Other Forms of Intervention	364	(1)
Summary	364	(1)
The Treatment of Chemical Dependency	365	(9)
Introduction	365	(1)
Characteristics of the Substance-Abuse Rehabilitation Professional	365	(2)
The Minnesota Model of Chemical-Dependency Treatment	367	(1)
The Treatment Plan	368	(1)
Other Treatment Formats for Chemical Dependency	369	(4)
Aftercare Programs	373	(1)
Summary	373	(1)
Treatment Formats for Chemical-Dependency Rehabilitation	374	(12)
Introduction	374	(1)
Outpatient Treatment Programs	374	(3)
Inpatient Treatment Programs	377	(4)
Inpatient or Outpatient Treatment?	381	(2)
Partial Hospitalization Options	383	(2)
Summary	385	(1)
The Process of Recovery	386	(11)
Introduction	386	(1)
The Decision to Seek Treatment	386	(1)
The Stages of Recovery	386	(4)
Specific Points to Address in the Treatment of Addiction to Common Drugs of Abuse	390	(6)
Summary	396	(1)
Problems Frequently Encountered in the Treatment of Chemical Dependency	397	(19)
Introduction	397	(1)
Limit Testing by Clients in Treatment	397	(1)
Treatment Noncompliance	397	(2)
Relapse and Relapse Prevention	399	(3)
``Cravings'' and ``Urges''	402	(1)
The ``Using'' Dream	403	(1)
Controlled Drinking	404	(1)
The Uncooperative Client	404	(2)
Toxicology Testing	406	(6)
The Addicted Patient With Chronic Pain Issues	412	(1)
Insurance Reimbursement Policies	412	(2)
D.A.R.E. and Psychoeducational Intervention Programs	414	(1)
Summary	415	(1)
Pharmacological Intervention Tactics and Substance Abuse	416	(16)
Introduction	416	(1)
Pharmacological Treatment of Alcohol Abuse and Dependence	416	(5)
Pharmacological Treatment of Opiate Addiction	421	(6)
Pharmacological Treatment of Cocaine Addiction	427	(1)
Pharmacological Treatment of Amphetamine Abuse/Dependence	428	(1)
Pharmacological Treatment of Nicotine Dependence	428	(3)
Summary	431	(1)
Substance Abuse/Addiction and Infectious Disease	432	(14)
Introduction	432	(1)
Why Is Infectious Disease Such a Common Complication of Alcohol/Drug Abuse?	432	(1)
The Pneumonias	433	(1)
Acquired Immune Deficiency Syndrome (AIDS)	434	(6)
Tuberculosis (TB)	440	(1)
Viral Hepatitis	441	(4)
Summary	445	(1)
Self-Help Groups	446	(16)
The Twelve Steps of Alcoholics Anonymous	446	(1)
Introduction	446	(1)
The History of AA	446	(1)
Elements of AA	447	(2)
AA and Religion	449	(1)
One ``A'' Is for Anonymous	450	(1)
AA and Outside Organizations	450	(1)
The Primary Purpose of AA	450	(2)
Of AA and Recovery	452	(1)
Sponsorship	452	(1)
AA and Psychological Theory	453	(1)
How Does AA Work?	453	(1)
Outcome Studies: The Effectiveness of AA	454	(2)
Narcotics Anonymous	456	(1)
Al-Anon and Alateen	456	(1)
Support Groups Other Than AA	457	(2)
Criticism of the AA/12-Step Movement	459	(1)
Summary	460	(2)
The Debate Around Legalization	462	(12)
Introduction	462	(1)
The Debate Over Medicalization	462	(1)
The ``War on Drugs'': The Making of a National Disaster	463	(10)
Summary	473	(1)
Crime and Drug Use	474	(13)
Introduction	474	(1)
Criminal Activity and Drug Use: Partners in a Dance?	474	(2)
Urine Toxicology Testing in the Workplace	476	(1)
Unseen Victims of Street Drug Chemistry	477	(1)
Drug Analogs: The ``Designer'' Drugs	478	(6)
Adulterants	484	(1)
Drug Use and Violence: The Unseen Connection	485	(1)
Summary	486	(1)
Appendix One: Alcohol Abuse Situation Sample Assessment	487	(3)
Appendix Two: Chemical Dependency Situation Sample Assessment	490	(3)
Appendix Three: The ``Jellinek'' Chart for Alcoholism	493	(2)
Appendix Four: Drug Classification Schedule	495	(1)
Glossary	496	(9)
References	505	(66)
Index	571