Preface | p. xiv |
Alcohol | p. 1 |
Once Upon a Time... | p. 1 |
Fermentation and Discovery of Distillation | p. 2 |
Alcohol Use in America | p. 3 |
Why Bother? | p. 4 |
Theories to Explain Alcohol Use | p. 5 |
Myths | p. 7 |
Alcohol Problems: The Fly in the Ointment | p. 8 |
Problems as Sin or Moral Failing | p. 8 |
Problems as a Legal Issue | p. 8 |
America's Response to Alcohol Problems | p. 9 |
Drunkenness versus Alcoholism | p. 11 |
History of Alcohol Treatment Efforts | p. 12 |
Public Policy and Alcohol | p. 14 |
Advertising | p. 18 |
Changing Norms | p. 22 |
Other Drug Use | p. 23 |
Tobacco | p. 23 |
Marijuana | p. 26 |
References and Suggested Reading | p. 29 |
Alcohol and Its Costs | p. 30 |
Who Drinks What, When, and Where | p. 31 |
Drinking Patterns | p. 32 |
Alcohol Problems | p. 37 |
Abuse and Dependence | p. 37 |
Economic Costs versus Economic Benefits | p. 38 |
Personal Costs | p. 40 |
Health Care and Alcohol | p. 45 |
References and Suggested Reading | p. 49 |
Alcohol and the Body | p. 51 |
Ingestion and Absorption | p. 51 |
Blood Alcohol Concentration | p. 53 |
Breakdown and Removal | p. 54 |
Alcohol's Acute Effects on the Body | p. 57 |
Digestive System | p. 57 |
Circulatory System | p. 57 |
Kidneys | p. 58 |
Liver | p. 58 |
Central Nervous System | p. 60 |
Acute Overdose and Toxicity | p. 63 |
Differences in Women | p. 64 |
Tolerance | p. 66 |
Alcohol as an Anesthetic | p. 67 |
Other Types of Alcohol | p. 67 |
The Influence of Expectations | p. 68 |
Advice for the Moderate Drinker | p. 69 |
Contraindications to Moderate Use | p. 69 |
Alcohol-Drug Interactions | p. 70 |
The Basis of Alcohol-Drug Interactions | p. 71 |
Problems Associated with Drinking and Intoxication | p. 74 |
Alcohol Use and Exercise | p. 75 |
In Conclusion | p. 76 |
References and Suggested Reading | p. 76 |
Alcohol Dependence | p. 77 |
Definitions | p. 77 |
Early Definitions | p. 79 |
Toward Uniformity in Terminology | p. 80 |
A Disease? | p. 82 |
Implications of Disease Classification | p. 82 |
Criticisms of the Disease Concept | p. 83 |
Natural History | p. 87 |
Jellinek's Phases of Alcoholism | p. 87 |
Types of Alcoholism: Jellinek's Species | p. 89 |
Current Thinking | p. 90 |
Guides for Diagnosis | p. 91 |
NCA Criteria | p. 91 |
Diagnostic Criteria of the American Psychiatric Association | p. 93 |
Natural History of Alcoholism: Jellinek Revisited | p. 96 |
References and Suggested Reading | p. 98 |
Etiology of Alcohol Dependence | p. 99 |
Public Health Model | p. 99 |
The Agent | p. 100 |
The Host-Genetic Factors | p. 102 |
Nature and Nurture | p. 103 |
Twin and Adoption Studies | p. 103 |
Studies of Nonalcoholic Blood Relatives | p. 105 |
Genetic Markers | p. 106 |
Familial versus Nonfamilial Alcohol Dependence: So What? | p. 111 |
The Host-Personality and Psychological Makeup | p. 111 |
Psychological Needs | p. 112 |
Early Psychological Approaches | p. 113 |
Personality Theories Applied to Alcohol Dependence | p. 113 |
Current Thinking | p. 115 |
The Environment-Sociological Factors | p. 119 |
Cultural Orientation | p. 119 |
Drinking Styles and Alcohol Problems | p. 125 |
Influence of Cultural Subgroups | p. 126 |
Legal Sanctions and Approaches | p. 126 |
Cross-Cultural Comparisons | p. 129 |
Cultural Influences on Recovery | p. 134 |
Views in the Twenty-First Century | p. 135 |
References and Suggested Reading | p. 138 |
Medical Complications | p. 140 |
Visible Signs and Symptoms of Chronic Heavy Drinking | p. 141 |
Gastrointestinal System | p. 142 |
Irritation, Bleeding, and Malabsorption | p. 142 |
Pancreatitis | p. 143 |
Gallbladder Disease | p. 144 |
Liver Disease | p. 144 |
Gastrointestinal Cancers | p. 147 |
Hematological System | p. 147 |
Red Blood Cells | p. 148 |
White Blood Cells | p. 149 |
Platelets | p. 150 |
Clotting Factors and DIC | p. 150 |
Immune System | p. 150 |
Cardiovascular System | p. 151 |
Genitourinary System | p. 154 |
Urinary Tract | p. 154 |
Reproductive System and Pregnancy | p. 155 |
Respiratory System | p. 159 |
Endocrine System | p. 160 |
Cancer | p. 162 |
Skin | p. 163 |
Skeletal System | p. 164 |
Nervous System | p. 165 |
Dependence, Tolerance, Craving, and Withdrawal | p. 165 |
Alcohol Idiosyncratic Intoxication (Pathological Intoxication) | p. 167 |
Organic Brain Disease | p. 167 |
Nerve and Muscle Tissue Damage | p. 170 |
Subdural Hematomas | p. 171 |
Miscellaneous CNS Disturbances | p. 172 |
Neuropsychological Impairment | p. 172 |
Miscellaneous Effects | p. 173 |
Sleep and Sleep Disturbances | p. 175 |
Sleep Stages | p. 175 |
Sleep Disturbances | p. 176 |
Insomnia | p. 177 |
Alcohol's Effects on Sleep | p. 178 |
Blackouts | p. 179 |
Withdrawal Syndromes | p. 182 |
Hyperarousal | p. 183 |
Alcoholic Hallucinosis | p. 183 |
Convulsive Seizures | p. 184 |
Delirium Tremens | p. 185 |
Late Withdrawal Phenomenon | p. 187 |
Some Cautions | p. 187 |
References and Suggested Reading | p. 188 |
The Behavior of Dependence | p. 190 |
A Behavioral Composite | p. 190 |
How, If Not Why? | p. 191 |
Deteriorating Functioning | p. 197 |
Family and Friends | p. 198 |
Work | p. 200 |
Other Drugs of Abuse | p. 200 |
A Final Thought | p. 204 |
References and Suggested Reading | p. 205 |
Effects of Alcohol Problems on the Family | p. 206 |
The "Family Illness" | p. 206 |
The Family's Response | p. 207 |
The Family System | p. 210 |
Enabling | p. 211 |
Co-dependency | p. 212 |
Current Thinking | p. 213 |
Children in the Family | p. 214 |
Children in the Home | p. 214 |
Children's Coping Styles | p. 217 |
Adult Children | p. 218 |
Resiliency | p. 221 |
Genetic Vulnerability | p. 222 |
Alcohol Dependence in Other Family Members | p. 222 |
Other Substance Use and Its Impact on the Family | p. 223 |
References and Suggested Reading | p. 227 |
Evaluation and Treatment Overview | p. 229 |
Theoretical Perspectives | p. 230 |
Problems of Use | p. 231 |
Chronic Disease Framework | p. 232 |
Challenges of Problems Associated with Use | p. 234 |
Screening and Evaluation | p. 235 |
Laboratory Tests | p. 235 |
Screening Instruments | p. 236 |
Initial Follow-Up Questions | p. 242 |
Identifying Situations Requiring Medical Attention | p. 244 |
Substance Use History | p. 247 |
Clinical Style | p. 247 |
Motivation | p. 247 |
History Taking | p. 249 |
What's Next? | p. 251 |
Making a Referral | p. 251 |
Evaluation in a Substance Abuse Treatment Setting | p. 254 |
Treatment Planning and Treatment Settings | p. 257 |
Treatment of Alcohol Problems and Alcohol Abuse | p. 260 |
Alcohol Incidents | p. 260 |
Alcohol Abuse | p. 265 |
Treatment of Alcohol Dependence | p. 265 |
Obstacles to Treatment | p. 267 |
Factors in Successful Treatment | p. 268 |
Recovery Process | p. 269 |
Common Treatment Issues | p. 274 |
References and Suggested Reading | p. 285 |
Treatment Techniques and Approaches | p. 287 |
Individual Counseling | p. 287 |
Observation | p. 288 |
Feedback | p. 290 |
Education | p. 290 |
Self-Disclosure | p. 292 |
Client Responsibility | p. 294 |
Possible Mis-steps | p. 295 |
Problem Identification and Problem Solving | p. 296 |
The Therapeutic Relationship | p. 297 |
Case Management and Administrative Tasks | p. 299 |
Group Work | p. 299 |
Group as Therapy | p. 299 |
Types of Groups | p. 301 |
Group Functions | p. 302 |
Groups as a Diversion | p. 303 |
Working with Families | p. 304 |
Family Members Troubled by Another's Alcohol Use | p. 305 |
Family Interventions | p. 305 |
Family Treatment in Conjunction with Alcohol Treatment | p. 309 |
Suggestions for Working with Families during Treatment | p. 310 |
Family Issues | p. 311 |
Couples Therapy | p. 316 |
Self-Help for Families | p. 316 |
Self-Help | p. 318 |
Alcoholics Anonymous (AA) | p. 318 |
Other Self-Help Groups | p. 329 |
Which Self-Help Approach? | p. 332 |
Other Approaches | p. 333 |
Spiritual Counseling | p. 333 |
Meditation | p. 339 |
Activities Therapy | p. 340 |
Behavioral Approaches | p. 343 |
Pharmacotherapy | p. 351 |
Disulfiram (Antabuse) | p. 351 |
Anticraving Agents | p. 353 |
Treatment Matching | p. 354 |
References and Suggested Reading | p. 355 |
Special Populations | p. 357 |
Adolescents | p. 357 |
Developmental Issues | p. 358 |
Alcohol and Other Drug Use | p. 364 |
Associated Problems | p. 367 |
Working with Adolescents | p. 374 |
A Framework for Addressing Adolescent Substance Use/Problems | p. 378 |
Further Assessment and Treatment | p. 381 |
College Students | p. 391 |
Patterns of Alcohol and Other Drug Use | p. 391 |
Problems Associated with Substance Use | p. 395 |
Perceived Benefits Associated with Drinking | p. 398 |
Students at Risk | p. 399 |
Natural History of Collegians' Alcohol Use | p. 403 |
Impetus to Institutional Action | p. 409 |
Impediments to Campus Programs | p. 410 |
Campus Initiatives | p. 411 |
Intervention and Treatment | p. 414 |
Antismoking Efforts | p. 418 |
Closing Thoughts | p. 418 |
The Elderly | p. 419 |
Stresses of Aging | p. 420 |
Patterns of Alcohol and Other Drug Use | p. 427 |
Alcohol Use and Health Status | p. 431 |
Alcohol Problems | p. 431 |
Prevention | p. 438 |
Working with Elderly People | p. 438 |
Women | p. 441 |
Gender Differences | p. 441 |
Differences among Women | p. 443 |
Natural History of Alcohol and Other Drug Problems in Women | p. 446 |
Assessment | p. 450 |
Treatment Approaches | p. 451 |
Treatment Themes | p. 451 |
Treatment Issues for Pregnant Women | p. 455 |
The Workplace | p. 456 |
Some Basic Statistics | p. 456 |
High-Risk Factors | p. 461 |
The Workplace Response | p. 461 |
Workplace Interventions | p. 462 |
Implications for Treatment | p. 463 |
Other Special Populations | p. 464 |
References and Suggested Reading | p. 466 |
Other Psychiatric Considerations | p. 472 |
Suicide Evaluation and Prevention | p. 472 |
Statistics and High-Risk Factors | p. 473 |
How to Ask about Suicide | p. 474 |
Responding to Suicidal Patients | p. 475 |
Mental Status Examination | p. 478 |
Major Categories of Co-occurring Psychiatric Illness | p. 478 |
Mood Disorders | p. 479 |
Disorders Involving Psychosis | p. 483 |
Anxiety Disorders | p. 485 |
Personality Disorders | p. 487 |
Attention-Deficit/Hyperactivity Disorder | p. 488 |
Psychiatric Disorders Due to a General Medical Condition | p. 489 |
Other Drug Dependence and Alcohol Abuse/Dependence | p. 490 |
Other Addictive Behaviors | p. 491 |
Clinical Considerations | p. 491 |
Homelessness, Alcohol Use, and Chronic Mental Illness | p. 492 |
Psychotropic Medications | p. 493 |
Antipsychotic Medications | p. 495 |
Antidepressant Medications | p. 497 |
Mood Stabilizers | p. 499 |
Anti-Anxiety Agents | p. 500 |
References and Suggested Reading | p. 502 |
Drugs of Abuse Other Than Alcohol | p. 504 |
Drug Use Patterns | p. 504 |
Age | p. 505 |
Gender | p. 506 |
Education | p. 506 |
Employment | p. 507 |
Geographic Region | p. 507 |
Social Costs | p. 507 |
Public Perceptions and Public Policies | p. 508 |
Legal Status | p. 508 |
Early Control Efforts | p. 509 |
Sources of Illicit Drugs | p. 514 |
Reducing Drug Diversion | p. 515 |
Basic Pharmacological Concepts | p. 517 |
How to Think about Drug Use | p. 517 |
Route of Administration | p. 517 |
Site of Action | p. 518 |
Solubility in Fat and/or Water | p. 519 |
Metabolism | p. 520 |
Withdrawal | p. 520 |
Abuse Potential | p. 520 |
Problems | p. 522 |
Toxicity and Overdose | p. 523 |
Classification Schemas for Substances of Abuse | p. 523 |
Licit versus Illicit | p. 524 |
DEA Schedule | p. 525 |
Pharmacological Effects | p. 526 |
Major Classes of Commonly Abused Drugs | p. 527 |
Nicotine | p. 527 |
Opiates | p. 533 |
Sedative-Hypnotics (Central Nervous System Depressants) | p. 539 |
Stimulants | p. 541 |
Hallucinogens and Dissociatives | p. 545 |
Cannabinoids | p. 549 |
Inhalants | p. 552 |
Anabolic Androgenic Steroids | p. 555 |
Caffeine | p. 561 |
Other Psychoactive Drugs Used Worldwide | p. 566 |
Clinical Issues | p. 568 |
Assessment | p. 568 |
Treatment Goals | p. 568 |
Harm Reduction | p. 569 |
Pharmacological Treatment | p. 571 |
Pregnancy and the Use of Drugs Other Than Alcohol | p. 573 |
International Comparisons | p. 578 |
References and Suggested Reading | p. 580 |
Odds 'n' Ends | p. 583 |
Beyond Counseling | p. 583 |
Educational Activities | p. 583 |
Training Others | p. 585 |
Prevention | p. 587 |
The Real World | p. 598 |
Being a Professional Colleague | p. 598 |
Selecting a Professional Position | p. 604 |
Being a Professional | p. 606 |
Certification and Licensure | p. 607 |
Ethics | p. 609 |
Basic Principles | p. 609 |
Confidentiality | p. 611 |
Setting Boundaries | p. 613 |
Counselors with "Two Hats" | p. 617 |
Clinician Impairment and Relapse | p. 618 |
References and Suggested Reading | p. 621 |
Organizations and Resources in the Substance Abuse Field | p. 623 |
The Interaction Effects of Alcohol with Other Drugs | p. 634 |
Diagnostic Criteria: Substance Use Disorders | p. 638 |
Index | p. 642 |
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