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Concepts of Chemical Dependency

ISBN: 9780534357559 | 0534357555
Edition: 4th
Format: Paperback
Publisher: Brooks Cole
Pub. Date: 7/3/1998

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SummaryTable of Contents
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.

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.

1 Recreational Chemical Use in the United States
1(10)
Who "Treats" Those Who Are Addicted to Chemicals?
2(1)
The Scope... MORE
3(5)
The Cost of Chemical Abuse and Addiction in the United States
8(2)
Why Is It So Difficult to Understand the Drug Abuse Problem in the United States?
10(1)
Summary
10(1)
2 Substance Abuse and Addiction
11(8)
The Continuum of Chemical Use
11(2)
Definitions of Terms Used in This Book
13(2)
The Growth of New "Addictions"
15(1)
What Do We Really Know about the Addictive Disorders?
15(1)
The State of the Art: Unanswered Questions, Uncertain Answers
16(2)
Summary
18(1)
3 An Introduction to Pharmacology
19(15)
Drug Forms and How Drugs Are Administered
20(2)
Bioavailability
22(5)
The Drug Half-Life
27(1)
The Effective Dose
28(1)
The Lethal Dose Index
28(1)
The Therapeutic Index
28(1)
Peak Effects
29(1)
The Site of Action
29(1)
Receptor Sites
30(2)
The Blood-Brain Barrier
32(1)
Summary
33(1)
4 An Introduction to Alcohol
34(12)
A Brief History of Alcohol
34(1)
How Alcohol Is Produced
35(1)
Alcohol Today
36(1)
Scope of the Problem of Alcohol Use
36(1)
The Pharmacology of Alcohol
36(2)
The Biotransformation of Alcohol
38(1)
The Blood Alcohol Level
39(1)
Subjective Effects of Alcohol
40(1)
Effects of Intoxicating Doses of Alcohol for the Average Drinker
41(1)
Medical Complications of Alcohol Use in the Average Drinker
42(3)
Alcohol Use and Accidental Injury or Death
45(1)
Summary
45(1)
5 Chronic Alcohol
46(19)
Scope of the Problem
46(1)
The "Typical" Alcohol-Dependent Person
47(1)
Alcohol Tolerance, Dependence, and Craving: Signposts of Addiction
47(2)
Complications of Chronic Alcohol Use
49(15)
Summary
64(1)
6 Barbiturates and Barbituratelike Drugs
65(11)
Early Pharmacological Therapy of Anxiety Disorders and Insomnia
65(1)
History and Current Medical Uses of the Barbiturates
66(1)
The Pharmacology of Barbiturates
67(2)
Subjective Effects of Barbiturates at Normal Dosage Levels
69(1)
Complications of the Barbiturates at Normal Dosage Levels
69(2)
Effects of the Barbiturates at Above-Normal Dosage Levels
71(1)
Tolerance of and Dependence on Barbiturates
72(1)
Barbituratelike Drugs
73(2)
Summary
75(1)
7 Benzodiazepines and Similar Agents
76(17)
Medical Uses of the Benzodiazepines
76(1)
Pharmacology of the Benzodiazepines
77(3)
Benzodiazepine Tolerance, Abuse, and Addiction
80(2)
Complications Caused by Benzodiazepine Use at Normal Dosage Levels
82(3)
Subjective Experience of Benzodiazepine Use
85(1)
Long-Term Consequences of Chronic Benzodiazepine Use
86(2)
Buspirone: The First Decade
88(2)
Zolpidem
90(1)
Rohypnol: A New Drug of Abuse
91(1)
Summary
92(1)
8 Amphetamines and Central Nervous System Stimulants
93(13)
The Amphetaminelike Drugs
93(1)
The Amphetamines
94(2)
Scope of the Problem of Stimulant Abuse and Addiction
96(1)
Medical Uses of Amphetamines and CNS Stimulants
96(1)
Pharmacology of the Amphetamines
97(2)
Methods of Amphetamine Abuse
99(1)
Subjective Experience of Amphetamine Use
99(1)
Side Effects of Amphetamine Use at Normal Dosage Levels
100(1)
Consequences of Amphetamine Abuse
100(3)
"Ice"
103(1)
"Kat"
104(1)
Summary
105(1)
9 Cocaine
106(18)
A Brief Overview of Cocaine
106(1)
Cocaine in Recent U.S. History
107(1)
Current Medical Uses of Cocaine
108(1)
Scope of the Problem of Cocaine Abuse and Addiction
108(1)
Pharmacology of Cocaine
109(2)
How Illicit Cocaine Is Produced
111(1)
How Cocaine Is Abused
112(2)
Effects of Cocaine Subjective When It Is Abused
114(1)
Complications of Cocaine Abuse/Addiction
115(6)
Withdrawal and Recovery from Central Nervous System Stimulant Abuse
121(2)
Summary
123(1)
10 Marijuana
124(11)
History of Marijuana Use in the United States
124(2)
Marijuana--Technically a Plant, Not a Drug
126(1)
Scope of the Problem
126(1)
Pharmacology of Marijuana
127(1)
Methods of Administration
128(1)
Subjective Effects of Marijuana
129(1)
Adverse Effects of Occasional Marijuana Use
130(1)
Consequences of Chronic Marijuana Use
130(3)
The Addiction Potential of Marijuana
133(1)
The Treatment of Marijuana Abuse/Addiction
134(1)
Summary
134(1)
11 Opiate
135(20)
I. The Medical Uses of Narcotic Analgesics
135(10)
A Short History of the Narcotic Analgesics
135(2)
The Classification of Analgesics
137(1)
Where Opium Is Produced
137(1)
Current Medical Uses of the Narcotic Analgesics
137(1)
Pharmacology of the Narcotic Analgesics
138(3)
Subjective Effects of Narcotic Analgesics When Used in Medical Practice
141(1)
Complications Caused by Narcotic Analgesics When Used in Medical Practice
141(2)
Fentanyl
143(1)
Buprenorphine
144(1)
II. Opiates as Drugs of Abuse
145(10)
Overview
145(2)
Methods of Opiate Abuse
147(1)
Scope of the Problem of Opiate Abuse and Addiction in the United States
148(4)
Complications Caused by Opiate Abuse and Addiction
152(1)
Opiate Overdose
153(1)
Is Treatment of Opiate Addiction Worthwhile?
154(1)
Summary
154(1)
12 Over-the-Counter Analgesics
155(18)
A Short History of Pain Management
155(2)
Medical Uses of the OTC Analgesics
157(3)
Pharmacology of the OTC Analgesics
160(3)
Normal Dosage Levels of Over-the-Counter Analgesics
163(2)
Complications Caused by Use of Over-the-Counter Analgesics
165(5)
Overdose of OTC Analgesics
170(2)
Summary
172(1)
13 Hallucinogens
173(14)
Scope of the Problem
174(1)
Pharmacology of the Hallucinogens
174(2)
Subjective Effects of Hallucinogens
176(2)
Phencyclidine (PCP)
178(3)
Complications of PCP Abuse
181(1)
Ecstasy: Latest in a Long Line of "Better" Hallucinogens?
182(4)
Summary
186(1)
14 Inhalants and Aerosols
187(8)
The History of Inhalant Abuse
187(1)
The Pharmacology of the Inhalants
188(1)
Scope of the Problem
189(2)
Method of Administration
191(1)
Subjective Effects of Inhalants
191(1)
Complications from Inhalant Abuse
191(2)
Anesthetic Misuse
193(1)
Abuse of Nitrites
194(1)
Summary
194(1)
15 Anabolic Steroids
195(8)
An Overview of the Anabolic Steroids
195(1)
Medical Uses of Anabolic Steroids
196(1)
The Legal Status of Anabolic Steroids
196(1)
Scope of the Problem of Steroid Abuse
196(1)
Sources and Methods of Steroid Abuse
196(1)
Problems Associated with Anabolic Steroid Abuse
197(1)
Complications of Steroid Abuse
198(3)
Are Anabolic Steroids Addictive?
201(1)
The Treatment of Anabolic Steroid Abuse
202(1)
Summary
202(1)
16 Tobacco Products and Nicotine
203(20)
Scope of the Problem
204(1)
Pharmacology of Cigarette Smoking
205(4)
Subjective Effects of Nicotine Use
209(1)
Nicotine Addiction
210(3)
Complications of the Chronic Use of Tobacco
213(7)
The Treatment of Nicotine Addiction
220(2)
Summary
222(1)
17 The Medical Model of Chemical Addiction
223(14)
Why Do People Use Chemicals?
223(1)
Factors That Influence Recreational Drug Use
223(5)
What Do We Mean When We Say That Someone Is Addicted to Chemicals?
228(1)
The Medical Model of Drug Addiction
229(6)
The Personality Predisposition Theories of Substance Abuse
235(1)
Summary
236(1)
18 Are People Predestined to Become Addicted to Chemicals?
237(14)
Reaction against the Disease Model of Addiction
237(5)
Then What Exactly Are the Addictive Disorders?
242(4)
The Personality Predisposition Theories of Substance Abuse
246(2)
The Final Common Pathway Theory of Addiction
248(2)
Summary
250(1)
19 Addiction as a Disease of the Human Spirit
251(12)
Diseases of the Mind--Diseases of the Spirit: The Mind-Body Question
252(1)
The Growth of Addiction: The Circle Narrows
253(1)
The Circle of Addiction: The Addicted Priorities
254(1)
Some Games of Addiction
255(2)
Honesty as a Part of the Recovery Process
257(1)
False Pride: The Disease of the Spirit
258(2)
Denial, Rationalization, Projection, and Minimization: The Four Musketeers of Addiction
260(2)
Summary
262(1)
20 Chemicals and the Neonate
263(16)
Statement of the Problem
264(1)
The Fetal Alcohol Syndrome
264(2)
Cocaine Use during Pregnancy
266(4)
Amphetamine Use during Pregnancy
270(1)
Narcotic Analgesic Use during Pregnancy
271(2)
Marijuana Use during Pregnancy
273(1)
Benzodiazepine Use during Pregnancy
274(1)
Hallucinogen Use during Pregnancy
274(1)
Buspirone Use during Pregnancy
274(1)
Bupropion Use during Pregnancy
274(1)
Disulfiram Use during Pregnancy
275(1)
Cigarette Use during Pregnancy
275(1)
Over-the-Counter Analgesic Use during Pregnancy
276(1)
Inhalant Abuse during Pregnancy
277(1)
Blood Infections
278(1)
Summary
278(1)
21 Hidden Faces of Chemical Dependency
279(13)
Women and Addiction: An Often Unrecognized Problem
279(3)
Differing Effects of Common Drugs of Abuse on Men and Women
282(2)
Addiction and the Elderly
284(4)
The Homosexual and Substance Abuse
288(2)
Substance Abuse and the Disabled
290(1)
Substance Abuse and Ethnic Minorities
290(1)
Summary
291(1)
22 The Dual-Diagnosis Client
292(12)
Definitions
292(1)
Dual-Diagnosis Clients: A Diagnostic Challenge
293(1)
Why Worry about the Dual-Diagnosis Client?
294(1)
The Scope of the Problem
295(1)
Characteristics of Dual-Diagnosis Clients
295(3)
Problems in Working with Dual-Diagnosis Clients
298(2)
Treatment Approaches
300(3)
Summary
303(1)
23 Chemical Abuse by Children and Adolescents
304(18)
Scope of the Problem
305(5)
Tobacco Use by Children and Adolescents
310(2)
Why Do Adolescents Use Chemicals?
312(2)
The Adolescent Abuse/Addiction Dilemma: Or, How Much Is Too Much?
314(5)
Possible Diagnostic Criteria for Adolescent Drug/Alcohol Problems
319(1)
The Special Needs of the Adolescent in a Substance Abuse Rehabilitation Program
320(1)
Summary
321(1)
24 Codependency and Enabling
322(12)
Enabling
322(3)
Codependency
325(5)
Reactions to the Concept of Codependency
330(3)
Summary
333(1)
25 Addiction and the Family
334(13)
Scope of the Problem
335(1)
Addiction and Marriage
335(2)
Addiction and the Family
337(3)
The Adult Child of Alcoholics (ACOA) Movement
340(5)
Summary
345(2)
26 The Evaluation of Substance Use Problems
347(17)
The Theory behind Alcohol and Drug Use Evaluations
347(1)
Screening
348(2)
Assessment
350(1)
Diagnosis
351(1)
The Assessor and Data Privacy
352(1)
Diagnostic Rules
353(2)
The Assessment Format
355(5)
Other Sources of Information: Medical Test Data
360(1)
Psychological Test Data
361(1)
The Outcome of the Evaluation Process
362(2)
27 The Process of Intervention
364(10)
A Definition of Intervention
364(1)
Characteristics of the Intervention Process
365(1)
The Mechanics of Intervention
365(4)
Intervention and Other Forms of Chemical Addiction
369(1)
The Ethics of Intervention
369(1)
Legal Intervention
370(1)
Treatment or Incarceration: When Is Treatment Appropriate?
371(1)
Other Forms of Intervention
372(1)
Summary
373(1)
28 The Treatment of Chemical Dependency
374(10)
Characteristics of the Substance Abuse Rehabilitation Professional
374(1)
Confrontation and Other Treatment Techniques
375(1)
The Minnesota Model of Chemical Dependency Treatment
376(1)
The Treatment Plan
377(1)
Other Treatment Formats for Chemical Dependency
378(5)
Aftercare Programs
383(1)
Summary
383(1)
29 Treatment Formats for Chemical Dependency Rehabilitation
384(13)
Outpatient Treatment Programs
384(3)
Impatient Treatment Programs
387(2)
Is There a Legitimate Need for Inpatient Treatment?
389(3)
Inpatient or Outpatient Treatment?
392(4)
Summary
396(1)
30 Recovery
397(9)
The Stages of Recovery
397(4)
Should Abstinence Be the Goal of Treatment?
401(1)
Specific Points to Address with Common Drugs of Abuse
401(4)
Summary
405(1)
31 Problems in Treating Chemical Dependency
406(15)
Limit Testing by Clients in Treatment
406(1)
Treatment Noncompliance
407(1)
Relapse and Relapse Prevention
407(4)
Chemical Use--Craving and Urges
411(1)
Controlled Drinking
412(1)
Clients Who Appear for Their Appointment while under the Influence of Chemicals
413(1)
Toxicology Testing as a Measure of Treatment Compliance and Drug Use
413(5)
Insurance Reimbursement Policies
418(2)
Summary
420(1)
32 Pharmacological Intervention Tactics and Substance Abuse
421(17)
The Pharmacological Treatment of Alcohol Abuse and Dependence
421(5)
The Pharmacological Treatment of Narcotics Addiction
426(4)
LAAM
430(1)
The Pharmacological Treatment of Cocaine Addiction
431(3)
Pharmacological Treatment of Nicotine Dependence
434(3)
Summary
437(1)
33 Infections Frequently Caused by Recreational Substance Abuse
438(16)
Why Is Infectious Disease Such a Common Complication of Alcohol/Drug Abuse?
438(2)
Acquired Immune Deficiency Syndrome (AIDS)
440(9)
Tuberculosis (TB)
449(1)
Viral Hepatitis
450(3)
Summary
453(1)
34 Crime and Drug Use
454(19)
Scope of the Problem of Drug-Related Criminal Behavior
454(3)
The Drug Underworld and Crime
457(3)
The Dilemma of Drug-Related Criminal Activity
460(1)
The "War on Drugs": Is It Time to Declare a Winner?
460(1)
Should Drugs Be Legalized?
461(4)
Drug Use and Violence: The Unseen Connection
465(1)
Unseen Victims of Street Drug Chemistry
466(1)
Drug Analogs: The "Designer" Drug
467(3)
GHB
470(1)
Summary
471(2)
35 Self-Help Groups
473(14)
The Twelve Steps of Alcoholics Anonymous
473(1)
The History of AA
474(1)
Elements of AA
474(2)
AA and Religion
476(1)
One "A" Is for Anonymous
476(1)
AA and Outside Organizations
477(1)
The Primary Purpose of AA
477(2)
Of AA and Recovery
479(1)
Sponsorship
479(1)
AA and Psychological Theory
480(1)
How Does AA Work?
480(1)
Outcome Studies: The Effectiveness of AA
481(2)
Narcotics Anonymous
483(1)
Al-Anon and Alateen
484(1)
Support Groups Other than AA
484(2)
Summary
486(1)
Appendix 1 Sample Assessment: Alcohol Abuse Situation487(4)
Appendix 2 Sample Assessment: Chemical Dependency Situation491(5)
References496(49)
Index545

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