Concepts of Chemical Dependency

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ISBN: 9780534537227 | 0534537227
Cover: Paperback
Copyright: 7/9/2001

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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.

Why Worry about Recreational Chemical Use in the United States?

(11)

Introduction

(1)

Who ``Treats'' Those Who Abuse or Are Addicted to Chemicals?

(1)

The Scope of the Problem of Chemical Abuse and Addiction

(4)

The Cost of Chemical Abuse and Addiction in the United States

(2)

Summary

(2)

What Do We Mean When We Say Substance Abuse and Addiction?

(7)

Introduction

(1)

The Continuum of Chemical Use

(2)

Definitions of Terms to Be Used in This Book

(2)

What Do We Really Know about the Addictive Disorders?

(1)

The State of the Art: Unanswered Questions, Uncertain Answers

(1)

Summary

(1)

The Medical Model of Chemical Addiction

(12)

Introduction

(1)

Why Do People Abuse Chemicals?

(3)

What Do We Mean When We Say That Someone Is ``Addicted'' to Chemicals?

(8)

Summary

(1)

Are People Predestined to Become Addicted to Chemicals?

(14)

Introduction

(1)

Multiple Models

(1)

Reaction Against the Disease Model of Addiction

(11)

The Final Common Pathway Theory of Addiction

(2)

Summary

(1)

Addiction as a Disease of the Human Spirit

(11)

Introduction

(1)

Diseases of the Mind and Diseases of the Spirit: The Mind-Body Question

(1)

The Growth of Addiction: The Circle Narrows

(1)

The Circle of Addiction: Addicted Priorities

(1)

Some Games of Addiction

(1)

Honesty as a Part of the Recovery Process

(1)

False Pride: The Disease of the Spirit

(2)

Projection, Denial, Rationalization, and Minimization: The Four Musketeers of Addiction

(2)

Summary

(2)

An Introduction to Pharmacology

(14)

Introduction

(1)

The Prime Effect and Side Effects of Chemicals

(1)

Drug Forms and How Drugs Are Administered

(2)

Bioavailability

(4)

Key Considerations in Assessing the Effects of Chemicals

(3)

Sites and Structures of Special Importance in Pharamacology

(3)

Summary

(1)

An Introduction to Alcohol

(10)

Introduction

(1)

A Brief History of Alcohol

(1)

How Alcohol Is Produced

(1)

Alcohol Today

(1)

Scope of the Problem of Alcohol Use

(1)

The Pharmacology of Alcohol

(2)

The Blood Alcohol Level

(1)

Subjective Effects of Alcohol on the Individual

(2)

Medical Complications of Alcohol Use in the Average Drinker

(2)

Alcohol Use and Accidental Injury or Death

(1)

Summary

(1)

Chronic Alcohol Abuse and Addiction

(16)

Introduction

(1)

Scope of the Problem

(1)

The ``Typical'' Alcohol-Dependent Person

(1)

Alcohol Tolerance, Dependency, and ``Craving'': Signposts of Alcoholism

(2)

Complications of Chronic Alcohol Use

(12)

Summary

(1)

Abuse of and Addiction to the Barbiturates and Barbiturate-like Drugs

(10)

Introduction

(1)

Early Pharmacological Therapy for Anxiety Disorders and Insomnia

(1)

History and Current Medical Uses of the Barbiturates

(1)

Pharmacology of the Barbiturates

(2)

Subjective Effects of Barbiturates at Normal Dosage Levels

(1)

Complications of the Barbiturates at Normal Dosage Levels

(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

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Concepts of Chemical Dependency

Summary

Table of Contents

Supplemental Materials