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Tables of Contents for Concepts of Chemical Dependency
Chapter/Section Title
Page #
Page Count
1 Recreational Chemical Use in the United States
1
10
Who "Treats" Those Who Are Addicted to Chemicals?
2
1
The Scope of the Problem of Chemical Abuse and Addiction
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 Situation
487
4
Appendix 2 Sample Assessment: Chemical Dependency Situation
491
5
References
496
49
Index
545