Healing Addiction An Integrated

In this groundbreaking book, the authors, including a nationally recognized addiction researcher, advocate the benefit of using psychopharmacological medications alongside more traditional treatment approaches. In addition, Healing Addiction reconciles the mismatch between scientific knowledge and treatment and bridges the gap between researchers and the self-help community.

Peter R. Martin, MD, is Professor of Psychiatry and Pharmacology at Vanderbilt University School of Medicine and Director of the Division of Addiction Medicineat Vanderbilt.

Bennett Alan Weinberg, Esq, is a medical and science writer, pharmaceutical educator, and attorney. He is the author, with Bonnie Bealer, of The Caffeine Advantage.

Bonnie K. Bealer is a researcher, writer, and editor.

Foreword

xi

Preface by Peter R. Martin, M.D.

xv

Preface by Bennett Alan Weinberg, Esq., and Bonnie K. Bealer

xxi

Acknowledgments

xxiii

Part I Out of Control: The Biopsychosocial Model of the Causes of Addiction

1 The Many Faces of Addiction

3

(12)

Who Is the Addict?

6

(2)

Symptoms of Addiction

8

(1)

Stages of Addiction

9

(1)

Primary and Secondary Addiction

10

(5)

2 The Historical Development of Drug Addiction

15

(7)

Changing Attitudes about Psychoactive Substances

16

(2)

Epidemiology: The Prevalence of Drug Use

18

(4)

3 Addiction as a Disease

22

(10)

The Drive to Use Drugs

23

(2)

Drugs and the Chemical Systems of the Brain

25

(1)

Neuroadaptation

26

(3)

Complications of Drug Abuse

29

(3)

4 Biopsychosocial Factors in Addiction

32

(9)

Biological Factors: Brain Chemistry

33

(1)

Psychological Factors

34

(1)

Social Factors

35

(1)

Biopsychosocial Factors and the Typical Course of Addiction

36

(5)

Part II The Integrated Approach: Pharmacopsychosocial Treatment of Addiction as a Bona Fide Mental Illness

5 The Players: Psychiatrists and Other Physicians, Therapists, Social Workers, Clergy, Family and Friends, and Support Groups

41

(11)

Addiction and Co-Occurring Psychiatric Conditions

43

(3)

Importance of Pharmaceuticals in Treatment

46

(2)

Advice to Caregivers: "Above All, Do No Harm!"

48

(4)

6 Identification and Diagnosis: Why Is It Difficult to Recognize Addiction?

52

(3)

7 Initiating Treatment

55

(11)

What Can the Family Do, and Why Is the Family Invaluable in Recovery?

58

(3)

How Should Treatment Continue after Detoxification or Stabilization?

61

(1)

Healing: When Treatment Requires Professional Supervision

62

(4)

8 Treatment Programs

66

(13)

Inpatient or Outpatient Treatment: Which Is More Effective or Gives the Better Value for the Money?

66

(2)

Who Really Decides What Treatment Is Best?

68

(2)

Psychosocial Treatment Programs

70

(2)

Medical Model

72

(2)

Safety of Medications in the Treatment of Primary Addiction: Why Become Addicted to a Doctor-Prescribed Medicine?

74

(5)

Part III Gaining Understanding: Treating Drug Addictions

9 Alcohol

79

(17)

The Case of Joe A.

81

(3)

Pharmacology

84

(1)

Chemical Considerations

85

(1)

Absorption, Distribution, and Elimination

86

(1)

Drug Interactions

87

(1)

Medical Complications

87

(5)

Other Issues Related to Treating Alcoholism

92

(2)

Alcoholism as a Paradigm for Understanding Drug Addiction

94

(2)

10 Heroin and Other Morphine-Related Drugs

96

(8)

Intoxication

96

(2)

The Case of Bob R.

98

(2)

Drug-Seeking Behavior: Sought-After Effects

100

(1)

Neuroadaptation

101

(3)

11 CNS Depressants: Barbiturates, Benzodiazepines, and Other Hypnotics and Tranquilizers

104

(11)

Patterns of Use

107

(1)

The Case of Mike R.

108

(3)

Drug-Seeking Behavior: Sought-After Effects

111

(1)

Neuroadaptation

111

(4)

12 Stimulants: Cocaine and Amphetamines

115

(11)

Pharmacology

116

(2)

Amphetamines, Including Methamphetamine

118

(1)

The Case of Roy T.

119

(2)

Patterns of Use

121

(1)

Drug-Seeking Behavior: Sought-After Effects

122

(1)

Neuroadaptation

122

(2)

Medical and Other Complications

124

(2)

13 Marijuana and Tobacco

126

(13)

Gateway Drug?

128

(2)

The Case of John T.

130

(2)

Patterns of Use

132

(1)

Intoxication

133

(1)

Pharmacology

134

(1)

Absorption, Distribution, Metabolism, and Excretion

134

(1)

Endocannabinoid System

134

(1)

Medical Complications

135

(1)

Note on Tobacco

136

(3)

Part IV Gaining Understanding: Treating Behavioral Addictions

14 What Are Behavioral Addictions?

139

(10)

The Case of Marilyn B.

144

(1)

Sex Addiction: Problematic Hypersexuality

145

(1)

The Case of Alex T.

146

(3)

15 Pathological Gambling

149

(11)

Epidemiology

151

(1)

The Case of John C.

152

(3)

Gambling Addiction: Behavioral Characteristics

155

(1)

Neuroadaptation?

156

(4)

16 Food

160

(23)

Hardwiring the Brain

163

(2)

Pleasure and Pain

165

(1)

Obesity

166

(6)

Anorexia Nervosa

172

(2)

Bulimia Nervosa

174

(2)

Summary and Comparison of the Eating Disorders

176

(1)

Epidemiology

177

(1)

Neuroadaptation: Tolerance, Dependence, and Withdrawal?

178

(5)

Part V Recovery as an Ongoing Process: Control Is Never Complete

17 Criteria for Treatment Success

183

(2)

18 Entering a New Life

185

(5)

Denial and "Slips"

186

(1)

Continuing Relationship with the Physician or Therapist

187

(1)

Should Recovering Addicts Become Treatment Professionals?

188

(2)

19 Managing Long-Term Treatment

190

(35)

Recovery Requires Maintaining Health

190

(1)

Honesty with the Primary Care Doctor Helps Both Patient and Doctor

191

(1)

The Primary Care Doctor: Partner in Recovery and Point Man of the Recovery Net

192

(1)

Beware of the Quickly Drawn Pen and the Ever-Ready Prescription Pad

193

(1)

Denial Is Incompatible with Recovery—Healing Requires Acceptance of Addiction(s)

194

(1)

Responsible Recovery—The Blame Game Helps No One

194

(1)

Drugs Are Not Dangerous—People Who Take Drugs Can Make Them Dangerous

195

(4)

Mutual Trust, Respect, and Open Communication in the Physician–Patient Relationship

199

(2)

Recovery Is More than Abstinence

201

(3)

Pharmacopsychosocial Treatment Knits a Strong Recovery Safety Net

204

(3)

Peer Mutual Support Fellowship: A Safe Haven in the Storm of Addiction

207

(1)

Recovery Requires Self-Examination—with Help from Others Who Care about the Recovering Addict

208

(2)

Professional Guidance on the Journey from Active Addiction to Recovery

210

(3)

Psychotherapy with a Professional Is Highly Compatible with a 12-Step Program

213

(3)

How Does a Professional Help Recovering Addicts Understand Themselves Better and Enable Them to Heal Their Addiction?

216

(1)

Addiction as a Way to Cope?

217

(2)

Despondency During Recovery

219

(1)

Wanting to Do Things Differently

220

(1)

Setting Priorities in Order to Do Things Differently

220

(2)

How to Make Changes after Determining Priorities

222

(1)

Recovery Means Understanding the Role of Fundamental Emotions in Addiction, Such as Trust and Shame

222

(3)

Appendix A Glossary of Terms

225

(9)

Appendix B Helpful Web Sites

234

(2)

Appendix C Epidemiological Tables

236

(2)

Appendix D Pharmacological Treatment of Withdrawal Syndromes from Substances of Abuse

238

(2)

Appendix E Pharmacological Maintenance Strategies for Substance Dependence after Detoxification Is Completed

240

(1)

Bibliography

241

(2)

Index

243

(4)

About the Authors

247

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Healing Addiction An Integrated Pharmacopsychosocial Approach to Treatment

Summary

Author Biography

Table of Contents

Supplemental Materials