The ASAM Principles of Addiction Medicine 6th Edition by Shannon Miller, ISBN-13: 978-1496370983

Description

The ASAM Principles of Addiction Medicine 6th Edition by Shannon Miller, ISBN-13: 978-1496370983

[PDF eBook eTextbook]

• Publisher: ‎ LWW; 6th edition (December 6, 2018)
• Language: ‎ English
• ISBN-10: ‎ 1496370988
• ISBN-13: ‎ 978-1496370983

Selected as a 2023 Doody’s Core Title! 

Thoroughly updated with the latest international evidence-based research and best practices, the comprehensive sixth edition of the American Society of Addiction Medicine’s (ASAM) official flagship textbook reviews the science and art behind addiction medicine and provides health care providers with the necessary information to not only properly diagnose and treat their patients, but to also serve as change agents to positively impact clinical service design and delivery, as well as global health care policy.

• Updated with the latest developments in Addiction Medicine and featuring chapters on emerging and high impact topics such as electronic cigarettes, cannabis as medicine, opioid overdose and opioid use disorder treatment, co-occurring pain and addiction, understanding addiction-related clinical trials, digital media as treatment platforms, TBI, neuromodulation, harm reduction, behavioral addictions, research behind spirituality and mutual help programs, co-occurring psychiatric disorders, and guidelines for using non-stigmatizing language.
• Covers all areas fundamental to Addiction Medicine, including neurobiology and pharmacology, epidemiology and prevention, management of intoxication and withdrawal syndromes, special populations, pharmacological and psychologically-based interventions, and medical consequences of addiction.
• Touches on international and military veteran-unique issues that are of special importance to the field.
• Brings together the world’s leading addiction medicine experts, editors, and contributors with expertise in internal medicine, psychiatry, emergency medicine, public health, neuroscience, pediatrics, obstetrics & gynecology, and other fields.
• Sought broadly as a critical textbook for graduate medical education, as well as for everyday clinical practice and policy-making, The ASAM Principles of Addiction Medicine, Sixth Edition is ideal for addiction medicine and addiction psychiatry fellows, residents, medical students, mental health practitioners, nurse practitioners, physician assistants, primary care physicians, researchers, and more.

Table of Contents:

Cover
Title Page
Copyright
Dedication
Section Editors
Contributors
Preface
A Note About Terminology
Acknowledgments
Contents
SECTION 1 Basic Science and Core Concepts
CHAPTER 1 Drug Addiction: The Neurobiology of Motivation Gone Awry
INTRODUCTION
ADDICTION: A DEVELOPMENTAL DISORDER
NEUROBIOLOGY OF ADDICTIVE DRUGS: BINGE–INTOXICATION STAGE
NEUROBIOLOGY OF DRUG ADDICTION: WITHDRAWAL–NEGATIVE AFFECT STAGE
NEUROBIOLOGY OF DRUG ADDICTION: PREOCCUPATION–ANTICIPATION (“CRAVING”) STAGE
VULNERABILITY TO ADDICTION
Genetic Factors
Environmental Factors
Comorbidity with Mental Illness
STRATEGIES TO COMBAT ADDICTION
Preventing Addiction
Treating Addiction
Pharmacological Interventions
Behavioral Interventions
Treating Comorbidities
CHALLENGES FOR SOCIETY
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 2 Recommended Use of Terminology in Addiction Medicine
INTRODUCTION
RECOMMENDED CONCEPTS AND TERMINOLOGY BY CONSTRUCT
Avoid Stigmatizing the Patient or the Condition, and Seek Medically Defined Terminology
The Spectrum of Use
The Disease
Treatment
CONCLUSIONS
CHAPTER 3 The Epidemiology of Substance Use Disorders
INTRODUCTION
SOME EPIDEMIOLOGICAL PRINCIPLES
ALCOHOL USE DISORDERS
Prevalence
Incidence
DRUG USE DISORDERS
Prevalence
Incidence
RECENT TRENDS OF ALCOHOL, TOBACCO, AND ILLICIT DRUG USE
REMISSION FROM SUBSTANCE USE DISORDERS
CORRELATES AND SUSPECTED RISK FACTORS
Gender
Age
Race and Ethnicity
Family History
Employment Status and Occupation
Marital Status
Educational Level
COMORBIDITY OF ALCOHOL AND DRUG USE DISORDERS
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 4 The Anatomy of Addiction
INTRODUCTION
PRIMER ON NEUROANATOMY
Limbic System
Interface of the Limbic System and the Basal Ganglia
Executive Function and Cortical Involvement
NEUROANATOMY OF DRUG REINFORCEMENT
Preclinical Studies of Drug Reinforcement
Psychostimulants
Opioids
Cannabinoids
NEUROANATOMY OF DRUG ADDICTION
MOVING FORWARD
CHAPTER 5 From Neurobiology to Treatment: Progress against Addiction
INTRODUCTION
BLOCKADE OF DRUG TARGETS
MIMICRY OF DRUG ACTION
BLOCKADE OF THE ADDICTION PROCESS
ACKNOWLEDGMENTS
CHAPTER 6 Clinical Trials in Substance-Using Populations
INTRODUCTION
ELEMENTS OF A CLINICAL TRIAL
TYPES OF CLINICAL TRIALS
Efficacy Trials
Phase IV Trials
Effectiveness Trials
Comparative Effectiveness Studies
FEATURES OF CLINICAL TRIALS
Randomization
Blinding
Sample Size, Power, and Effect Size
Statistical Analysis Plans
Statistical Significance and Effect Sizes
THE RESEARCH QUESTION DICTATES VARIOUS ASPECTS OF TRIAL DESIGN
Superiority Designs
Noninferiority Designs
Adaptive Designs
OUTCOME METRICS USED IN CLINICAL TRIALS
Quantification of Substance Use
Measuring Withdrawal Syndromes
Measuring Drug Craving
Measuring Cognitive Function
Psychiatric Scales
Addiction-Focused Scales
Reduction of HIV Risk Scales
Quality of Life Measures
Patient-Reported Outcome Measures
Pharmacokinetic Measures
Healthcare Service Utilization Measures
Cost Analysis–Related Measures
Treatment Adherence Measures
MONITORING AND QUALITY CONTROL
REPORTING RESULTS IN A JOURNAL ARTICLE
CONCLUSIONS
Acronyms Explained
CHAPTER 7 The Addiction Medicine Physician as a Change Agent for Prevention and Public Health
WE ARE RESPONSIBLE
PROTECTING AND PROMOTING THE PUBLIC HEALTH
THE ROLE OF THE ADDICTION MEDICINE PHYSICIAN
TRANSFORMATIONAL CHANGE
A PROVEN APPROACH TO EFFECTING CHANGE IN HEALTH CARE
Dr. Smart’s Emergence as a Change Agent
Dr. Smart Plots a Course
Dr. Smart and the SUD Standards of Care Team
Dr. Smart’s Initiative Gets Traction
The SUD Standards of Care Team Follows Through
The SUD Standards of Care Team Becomes Institutionalized
SUMMARY
SECTION 2 Pharmacology
CHAPTER 8 Pharmacokinetic, Pharmacodynamic, and Pharmacogenomic Principles
INTRODUCTION
BASIC PHARMACOLOGY CONCEPTS
Pharmacokinetics
Pharmacogenomics
Pharmacodynamics
Receptors
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 9 The Pharmacology of Alcohol
DEFINITION
SUBSTANCES INCLUDED IN THIS CLASS
FORMULATIONS AND METHODS OF USE
CLINICAL USES
BRIEF HISTORICAL FEATURES
EPIDEMIOLOGY
PHARMACOKINETICS
Absorption and Metabolism
PHARMACODYNAMICS
Central Nervous System
Other Organ Systems
DRUG–DRUG INTERACTIONS
NEUROBIOLOGY (MECHANISMS OF ADDICTION)
Molecular Sites of Alcohol Action
GABAA and Glycine Receptors
Glutamate Activated Ion Channels
Other Ion Channel Subtypes
Pharmacological Studies Implicating Other Neurotransmitter Systems
ADDICTION LIABILITY
Sensitization
Tolerance and Dependence
Toxicity States
Medical Complications
CONCLUSIONS/FUTURE RESEARCH
ACKNOWLEDGMENTS
CHAPTER 10 The Pharmacology of Nonalcohol Sedative Hypnotics
FORMULATIONS AND CHEMICAL STRUCTURE
BRIEF HISTORICAL FEATURES
PHARMACODYNAMICS
PHARMACOKINETICS
PHARMACOGENOMICS
DRUG–DRUG INTERACTIONS
SPECIAL CONSIDERATION OF CONCOMITANT USE OF BENZODIAZEPINES AND OPIOIDS
MECHANISM OF TOLERANCE AND WITHDRAWAL
ADDICTION LIABILITY
EPIDEMIOLOGY OF UNHEALTHY USE
TOXICITIES
MEDICAL COMPLICATIONS
CONCLUSION
CHAPTER 11 The Pharmacology of Opioids
DEFINITION OF DRUGS IN THE CLASS
SUBSTANCES INCLUDED IN THE CLASS
Naturally Occurring Agents
Synthetic Agents
Clinical Uses
Nonmedical Use of Prescription Medications (NUPM)
Historical Features
EPIDEMIOLOGY OF OPIOID USE DISORDER
Neurobiology, Mechanisms of Action, and Relationship to Addiction Liability
Distribution in CNS and Mediation of Different Functions
MOP-r Signaling Properties and Addiction Liability
PHARMACOKINETICS OF SPECIFIC DRUGS
Morphine Pharmacokinetics
Codeine Pharmacokinetics
Heroin (Diacetylmorphine) Pharmacokinetics
Oxycodone Pharmacokinetics
Meperidine Pharmacokinetics
Pentazocine Pharmacokinetics
Hydromorphone Pharmacokinetics
Hydrocodone Pharmacokinetics
Methadone Pharmacokinetics
Levo-alpha-acetylmethadol (LAAM) Pharmacokinetics
Buprenorphine Pharmacokinetics
PHARMACODYNAMICS
DRUG–DRUG INTERACTIONS
TOLERANCE DEVELOPMENT
TOXICITY STATES AND THEIR MEDICAL MANAGEMENT
MEDICAL COMPLICATIONS OF OPIOIDS
CONCLUSIONS AND FUTURE RESEARCH DIRECTIONS
CHAPTER 12 The Pharmacology of Stimulants
DEFINITION
SUBSTANCES INCLUDED
FORMULATIONS AND METHODS OF USE
Plant-Derived Stimulants
Synthetic Stimulants
Clinical Uses
Nonmedical Use and Addiction
HISTORICAL FEATURES
EPIDEMIOLOGY
PHARMACOKINETICS
Absorption and Distribution
Metabolism
Elimination
DRUG–DRUG INTERACTIONS
PHARMACODYNAMIC ACTIONS
Central Nervous System
NEUROBIOLOGY
Mechanisms of Action
FUTURE RESEARCH DIRECTIONS
ACKNOWLEDGMENT
CHAPTER 13 The Pharmacology of Caffeine
INTRODUCTION
DRUGS IN THE CLASS
HISTORY
EPIDEMIOLOGY
SOURCES OF CAFFEINE
THERAPEUTIC USES
NEUROBIOLOGY
Psychostimulant Pharmacological Profile of Caffeine
Adenosine A2A-Dopamine D2 Receptor Heteromers as Main Targets for the Psychomotor and Reinforcing Effects of Caffeine
Adenosine A1 Receptors as Main Targets for the Arousal Effects of Caffeine
PHARMACOKINETICS
Absorption and Distribution
Metabolism
Elimination
PHYSIOLOGICAL EFFECTS
SUBJECTIVE EFFECTS
PERFORMANCE EFFECTS
Cognitive Performance
Physical Performance
Withdrawal Reversal
REINFORCING EFFECTS
CAFFEINE TOLERANCE
CAFFEINE INTOXICATION
CAFFEINE WITHDRAWAL
CAFFEINE USE DISORDER
GENETICS
EFFECTS ON PHYSICAL HEALTH
Dietary Guidelines
Adverse Health Effects
Health Protective Effects
DRUG–DRUG INTERACTIONS
Nicotine and Cigarette Smoking
Alcohol
Alcohol and Energy Drinks
Other Drug Interactions
ACKNOWLEDGMENTS
CHAPTER 14 The Pharmacology of Nicotine and Tobacco
DRUGS IN THE CLASS
METHODS OF USE
HISTORICAL FEATURES
PHARMACOKINETICS
Absorption, Distribution, Metabolism, and Elimination
Biochemical Assessment of Exposure to Nicotine and Tobacco
Drug Interactions With Tobacco and Nicotine
PHARMACOLOGICAL ACTIONS
Central Nervous System
Psychoactive Effects
Genetic Predisposition
Psychiatric Comorbidity
Discrimination and Self-administration
Addiction
Withdrawal
NEUROBIOLOGICAL MECHANISMS OF ACTION
Nicotinic Acetylcholine Receptors
The Cholinergic Systems
Nicotinic Mechanisms in the CNS
Nicotine Influences on Dopaminergic Neurons
Nicotine Activates and Desensitizes nAChRs on Mesocorticolimbic Neurons
Hypotheses to Extrapolate the Cellular Results to People Who Smoke
Monoamine Oxidase and Tobacco Use Disorder
SYSTEMIC TOXICITY
Particulate and Gaseous Components of Tobacco Smoke
Cardiovascular, Pulmonary, and Oncological Toxicities
Other Physiological Effects and Toxicities
Tobacco and Pregnancy
Secondhand Smoke
Morbidity and Mortality
Nicotine and Other Addictions
Benefits of Stopping Smoking
ACKNOWLEDGMENTS
CHAPTER 15 The Pharmacology of Cannabinoids
INTRODUCTION
SUBSTANCES INCLUDED
FORMULATIONS
Natural Plant-Derived Cannabinoids
SYNTHETIC CANNABINOIDS
HISTORICAL FEATURES
EPIDEMIOLOGY
CANNABINOID RECEPTOR NEUROBIOLOGY
Cannabinoid Receptors
Mechanism of Action
ENDOCANNABINOID SYSTEM
Synthetic and Degradative Enzymes
ENDOCANNABINOID SIGNALING
Cannabinoid Pharmacokinetics
Cannabinoid Pharmacodynamics
Toxicity and Adverse Effects/Plant-Derived Cannabinoids and Endocannabinoids
Effects on Major Organ Systems
NONCLINICAL USE
Relative Addiction Liability
Synthetic Cannabinoids—Adverse Effects and Toxicity
Clinical Uses
Preclinical Studies—Ongoing
Results from Ongoing Phase 1 Clinical Trials
Drug–Drug Interactions
Conclusions and Future Research
ACKNOWLEDGMENTS
CHAPTER 16 The Pharmacology of Hallucinogens
DEFINITION
SUBSTANCES INCLUDED
FEATURES OF CLINICAL USE, NONMEDICAL USE, AND ADDICTION
Clinical Uses
Nonmedical Use and Addiction
HISTORICAL FEATURES
EPIDEMIOLOGY
NEUROBIOLOGY
Mechanisms of Action
Relative Addiction Liability
PHARMACOKINETICS AND PHARMACODYNAMICS
LSD
Psilocybin and Psilocin
DMT
Pharmacodynamics
Mescaline
MDMA
Other Serotonergic Hallucinogens
Salvinorin A
DRUG–DRUG INTERACTIONS
CONCLUSIONS AND FUTURE RESEARCH
CHAPTER 17 The Pharmacology of Dissociatives
DEFINITION (DRUGS IN THIS CLASS)
SUBSTANCES INCLUDED IN THIS CLASS
FORMULATIONS, METHODS OF USE
U.S. Food and Drug Administration–Approved Formulations
HISTORICAL FEATURES
EPIDEMIOLOGY
PHARMACOKINETICS
PHARMACODYNAMICS
DRUG–DRUG INTERACTIONS
NEUROBIOLOGY
Addiction Liability
Toxicity/Adverse Effects
Intoxication and Overdose
CONCLUSIONS AND FUTURE RESEARCH
CHAPTER 18 The Pharmacology of Inhalants
DEFINITION
SUBSTANCES INCLUDED IN THIS CLASS
Volatile Alkyl Nitrites
Nitrous Oxide
Volatile Solvents, Fuels, and Anesthetics
HISTORICAL FEATURES
History
EPIDEMIOLOGY
PHARMACOKINETICS
PHARMACODYNAMICS
ADDICTION LIABILITY
Tolerance and Dependence
Clinical Chemistry
TOXICITY/ADVERSE EFFECTS
Acute Effects
Chronic Toxicity
Neurotoxicity
Psychiatric Disorders
Effects on Major Organ Systems
Fetal Solvent Syndrome
FUTURE RESEARCH DIRECTIONS
ACKNOWLEDGMENT
CHAPTER 19 The Pharmacology of Anabolic–Androgenic Steroids
INTRODUCTION
DRUGS IN THE CLASS
New-Generation “Performance Enhancers”
At-Risk Populations
THERAPEUTIC USE AND UNHEALTHY USE
Therapeutic Use
Personality Profiles
ADVERSE EFFECTS
ADDICTION LIABILITY
Reward
Tolerance
Substance Use Disorder
Treatment Considerations
Diagnostic Classifications
ABSORPTION AND METABOLISM
MECHANISMS OF ACTION
FUTURE VISTAS
CHAPTER 20 Electronic Cigarettes
E-CIGARETTE, THE PRODUCT
CONSTITUENTS OF E-CIGARETTES AND THEIR AEROSOLS
Propylene Glycol and Vegetable Glycerin
Nicotine
Flavorants (Flavorings)
Contaminants
Volatile Organic Compounds
Particles
NICOTINE DELIVERY AND ADDICTION POTENTIAL
SECONDHAND AND THIRDHAND EXPOSURE
PREVALENCE OF E-CIGARETTE USE
E-CIGARETTE AS A POSSIBLE GATEWAY TO COMBUSTIBLE CIGARETTES
HEALTH EFFECTS OF E-CIGARETTES
E-CIGARETTE USE AND STOPPING SMOKING
E-cigarettes as a Clinical Tool
E-Cigarette Use and Stopping Smoking at the Population Level
WHAT TO TELL PATIENTS
OTHER ELECTRONIC NICOTINE DELIVERY SYSTEMS
OTHER SUBSTANCE USE WITH E-CIGARETTES
REGULATION OF E-CIGARETTES
ACKNOWLEDGMENTS
CHAPTER 21 Novel Psychoactive Substances: Their Recognition, Pharmacology, and Treatment
TREATMENT
SPECIFIC EXAMPLES OF NPS
NONPHARMACEUTICAL FENTANYL ANALOGUES
History
Pharmacology
Clinical Implications
Legal Status
KRATOM
History
Pharmacology
Clinical Implications
Legal Status
KROKODIL
History
Pharmacology
Clinical Implications
Legal Status
SALVIA DIVINORUM
History
Pharmacology
Clinical Implications
Legal Status
IDENTIFYING AND ACCESSING INFORMATION ON NEWLY EMERGING AND NOVEL PSYCHOACTIVE SUBSTANCES
SECTION 3 Diagnosis, Assessment, and Early Intervention
CHAPTER 22 Screening and Brief Intervention
INTRODUCTION
NATIONAL RECOMMENDATIONS ON THE IMPLEMENTATION OF UNHEALTHY SUBSTANCE USE SCREENING AND TREATMENT IN MEDICAL CARE SETTINGS
SCREENING AND BRIEF INTERVENTION: CLINICAL GUIDELINES
Clinical Approach to SBI Services in Primary Care Settings
SBI for Unhealthy Substance Use (Alcohol, Drugs, Tobacco): Approaches
Drug SBI
Alcohol SBI for Adults
SBI for Youth
CURRENT EVIDENCE ON SCREENING AND BRIEF INTERVENTION: A BRIEF SUMMARY
Screening and Brief Intervention for Unhealthy Alcohol Use
Screening and Brief Intervention for Unhealthy Drug Use
SBI for Prescription Opioid Misuse
Technology-Based Interventions for Unhealthy Drug Use
SYSTEMATIC REVIEWS AND META-ANALYSES OF SCREENING AND BRIEF INTERVENTIONS FOR UNHEALTHY ALCOHOL USE
INDIVIDUAL STUDIES OF SCREENING AND BRIEF INTERVENTION FOR UNHEALTHY ALCOHOL USE
Primary Care Settings
Adolescents and Young Adults
Older Adults
College Students
INDIVIDUAL STUDIES OF SCREENING AND BRIEF INTERVENTION FOR UNHEALTHY DRUG USE
Studies Suggesting Benefit of BI for Drug Use
Studies Suggesting No Benefit of BI for Unhealthy Drug Use versus Treatment as Usual
SUMMARY
ACKNOWLEDGMENTS
ALCOHOL
OTHER DRUGS
CONCLUSION AND RECOMMENDATIONS
CASE FINDING AND SCREENING
CLINICAL ASSESSMENT FOR RISK OF WITHDRAWAL
INITIAL MANAGEMENT OF WITHDRAWAL SYNDROMES
NEW CHALLENGES
INTERVENTION AND DISCHARGE PLANNING
EFFICACY OF BRIEF INTERVENTION
THE PHYSICIAN’S ROLE
EPIDEMIOLOGY
DIAGNOSIS
DIFFERENT CLINICAL MANIFESTATIONS IN THE ELDERLY
IMPACT OF ALCOHOL ON HEALTH
INTERVENTION
SUMMARY
CHAPTER 23 Laboratory Assessment
INTRODUCTION
APPROACH TO TESTING
Interpretation of Test Results
Body Fluids for Testing
Collection Procedures
Specimen Validity Testing
Laboratory Methods
Cutoff
On-Site Testing
Federal Regulations
Clinical Laboratories
SUBSTANCE-SPECIFIC TESTS
Alcohol
Amphetamines
Barbiturates
Benzodiazepines
Cocaine
Lysergic Acid Diethylamide
Marijuana
Opioids
Phencyclidine
Lab Testing for Newer Substances
Ethical Considerations
CONCLUSIONS
CHAPTER 24 Assessment
ASSESSMENT OF PATIENTS WITH SUBSTANCE USE
NEEDS OF DIFFERENT ASSESSORS
Primary Care Assessment Needs and Tools
Addiction Specialist Assessment Needs and Tools
Substance Use Disorder Treatment Provider Needs and Tools
Substance Use Disorder Researcher Needs
TASKS OF THE ASSESSMENT PROCESS
SOURCES OF ASSESSMENT INFORMATION
ASSESSMENT TOOLS
Screening Tool Results Can Provide Assessment Information
Diagnostic Assessment Tools
Intoxication and Withdrawal Assessment
Assessment Tools for Comorbid Conditions and Functioning
SUMMARY
CHAPTER 25 Environmental Approaches to Prevention: Communities and Contexts
INTRODUCTION
SCOPE OF THE PROBLEM
ENVIRONMENTAL VERSUS INDIVIDUAL APPROACHES TO PREVENTION
DOMAINS OF ENVIRONMENTAL PREVENTION
NINE EFFICACY TRIALS
MULTICOMPONENT ENVIRONMENTAL APPROACHES CONSIDERED
THE EMERGENCE OF ECOLOGIC RESEARCH
THE LOGIC OF ENVIRONMENTAL PREVENTION
ENVIRONMENTAL PREVENTION AND THE ROLE OF THE MEDICAL PROFESSIONALS
GLOSSARY
SECTION 4 Overview of Addiction Treatment
CHAPTER 26 Addiction Medicine in America: Its Birth, Early History, and Current Status (1750-2018)
CHAPTER OVERVIEW
INTRODUCTION
THE BIRTH OF ADDICTION MEDICINE
EARLY PROFESSIONALISM AND MEDICAL ADVANCEMENTS (1830-1900)
DEMEDICALIZATION AND THE COLLAPSE OF ADDICTION TREATMENT (1900-1935)
THE REBIRTH OF ADDICTION TREATMENT (1935-1970)
ADDICTION MEDICINE COMES OF AGE (1970-2018)
ORGANIZED ADDICTION MEDICINE TODAY
The American Society of Addiction Medicine
The American Academy of Addiction Psychiatrists
The American Board of Addiction Medicine
The Addiction Medicine Foundation
Defining the Field
Accredited Addiction Medicine Fellowships
The American Board of Preventive Medicine: Home to Addiction Medicine
The Addiction Medicine Fellowship Directors Association
Accreditation of Addiction Medicine Fellowships by the Accreditation Council for Graduate Medical Education (ACGME)
CHAPTER 27 Treatment of Unhealthy Alcohol Use: An Overview
INTRODUCTION
THE SPECTRUM OF SEVERITY IN UNHEALTHY ALCOHOL USE
MODERN APPROACHES TO TREATMENT
DEFINING THE PROBLEM: WHAT ARE TREATMENT OUTCOMES?
MEASURING DRINKING OUTCOMES
TAILORING TREATMENT TO THE CONTINUUM OF SEVERITY
Abstainers, Lower-risk Drinkers, and At-risk Drinkers
People with Alcohol Use Disorder
TREATMENT AND BEHAVIOR CHANGE
SYSTEMS OF CARE
INTEGRATING THE EVIDENCE AND PERSONALIZING PRACTICE
CHAPTER 28 The Treatment of Addiction: An Overview
INTRODUCTION
GOALS OF ADDICTION TREATMENT
TREATMENT SETTINGS
Withdrawal Management
Hospital Settings
Outpatient Programs
Partial Hospital Programs and Intensive Outpatient
RESIDENTIAL PROGRAMS, INCLUDING THERAPEUTIC COMMUNITY
Community Residential Rehabilitation
Case Management
Aftercare Programs
Sober Coaches, Recovery Coaches, and Other Support Services
Treatment in the Physician’s Office, Including Screening and Brief Interventions
Criminal Justice Settings for Mandated Treatment, Including Drug Courts
Prison-Based Treatment Programs
Community-Based Treatment for Criminal Justice Populations
TREATMENT SERVICES
Clinical Monitoring
Managing Intoxication and Withdrawal
Therapy
Cognitive–Behavioral Therapy
Motivational Enhancement Therapy
Community Reinforcement Approach Plus Vouchers
Voucher-Based Reinforcement Therapy in Methadone Treatment
Day Treatment With Abstinence Contingencies and Vouchers
Individual Psychotherapies
Treatment of the Adolescent With Multidimensional Family Therapy
Multisystemic Therapy
Computer-Assisted Therapy
PHARMACOLOGICAL THERAPIES
Opioid Agonist Treatment
Antagonist Treatment Using Naltrexone
CONCLUSION
CHAPTER 29 Integrated Care for Substance Use Disorder
INTRODUCTION
A BRIEF HISTORY OF 20TH CENTURY ADDICTION TREATMENT IN THE UNITED STATES
TOWARD INTEGRATED CARE FOR THE POPULATION OF PEOPLE WITH SUDS
The Early Identification/Intervention Stage of Care
The Stabilization Stage of Care
The Clinical Monitoring/Management Stage of Care
The Patient Self-Management Stage
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 30 The ASAM Criteria and Matching Patients to Treatment
INTRODUCTION
SELECTING APPROPRIATE SERVICES
Evolving Approaches to Treatment Matching
Uses of Placement Criteria
The Concept of “Unbundling”
UNDERSTANDING THE ASAM CRITERIA
Objectivity
Principles Guiding the Criteria
The ASAM Criteria and State Licensure or Certification
ASSESSMENT DIMENSIONS
Interactions Across Dimensions in Assessing for Level of Care
Continued Service and Transfer/Discharge Criteria
LEVELS OF CARE
PLACEMENT DILEMMAS
Co-occurring Disorders
Assessment of Imminent Danger
Mandated Level of Care or Length of Service
Logistical Impediments
The Need for a Safe Recovery Environment
Assuring Individualized Treatment
Fidelity to the Spirit and Content of the ASAM Criteria
Exceptions to the Patient Placement Criteria
Gathering Data to Improve Systems of Care
RESEARCH ON THE ASAM CRITERIA
THE ASAM CRITERIA SOFTWARE
CONCLUSIONS
CHAPTER 31 Linking Addiction Treatment With Other Medical and Psychiatric Treatment Systems
INTRODUCTION
POTENTIAL BENEFITS OF LINKED SERVICES
BARRIERS TO OPTIMAL LINKAGE
Medical Training
Payment and Service Linkage Issues
Stigma and Concerns about Confidentiality
MODELS OF LINKED SERVICES
Centralized Models
Chronic Disease Management Model
Distributive Models
Vulnerable Populations
PROSPECTS FOR IMPROVED LINKAGE
CHAPTER 32 Alternative Therapies for Substance Use Disorders
INTRODUCTION
HERBAL REMEDIES WITH ANTIADDICTIVE POTENTIAL
Corydalis yanhusuo
TRANSCUTANEOUS ELECTRICAL ACUPUNCTURE STIMULATION AS A NONINVASIVE ALTERNATIVE THERAPY FOR UNHEALTHY ALCOHOL AND DRUG USE
OPIOID WITHDRAWAL MANAGEMENT WITH TRANSCUTANEOUS ELECTRICAL ACUPUNCTURE STIMULATION
Animal Studies
Human Studies
Single Treatment
Multiple Treatments
PREVENTION OF CRAVING AND RELAPSE TO OPIOID USE
Animal Studies
Human Study of Cravings
ACUPUNCTURE AND UNHEALTHY ALCOHOL USE
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 33 Harm Reduction, Overdose Prevention, and Addiction Medicine
HARM REDUCTION DEFINITION AND PRINCIPLES
HISTORY OF HARM REDUCTION
THE INTEGRATION OF HARM REDUCTION AND ADDICTION TREATMENT
INTERVENTIONS THAT REDUCE THE HARMS OF SUBSTANCE USE
Practice Ready Interventions
Wider Venue Interventions
THREAT TO HARM REDUCTION: POTENTIAL FOR “CORPORATE CAPTURE” BY SUBSTANCE INDUSTRIES
CONCLUSION
CHAPTER 34 Quality Improvement for Addiction Treatment
INTRODUCTION
FRAMEWORK FOR CHANGE
National Academy of Medicine Reports
DEFINING AND MEASURING QUALITY TREATMENT AND OUTCOMES
Measuring Performance in Addiction Treatment Providers
Veterans Health Administration
National Quality Forum
ASAM Standard Workgroup
Certification of Office-Based Opioid Treatment Providers
ACCREDITATION FOR TREATMENT PROGRAMS
Accreditation Process
Accreditations for Opioid Treatment Programs
BUILDING SYSTEM CAPACITY TO DELIVER EFFECTIVE TREATMENTS
The NIATx Model of Process Improvement
NIATx 200
Advancing Recovery
ENSURING PRIMARY CARE PROVIDERS CAN IDENTIFY, TREAT OR REFER, AND MONITOR SUBSTANCE USE DISORDER
INTERNATIONAL EFFORTS: THE INTERNATIONAL CENTER FOR CREDENTIALING AND EDUCATION OF ADDICTION PROFESSIONALS
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 35 Nursing Roles in Addressing Addiction
INTRODUCTION
HISTORY OF DEVELOPMENT OF NURSING ROLES IN ADDICTION CARE
CURRENT TRENDS IN SUBSTANCE USE
LEVELS OF NURSING EDUCATION AND PRACTICE
GENERALIST’S ROLES RELATED TO ADDICTION
THE ADDICTION NURSE
ADDICTION NURSING WORKFORCE
CHAPTER 36 International Perspectives on Addiction Management*
INTRODUCTION
WORLDWIDE PREVALENCE OF PSYCHOACTIVE SUBSTANCE USE AND SUBSTANCE USE DISORDERS
INTERNATIONAL POLICY FRAMEWORKS FOR PSYCHOACTIVE SUBSTANCES
THE ROLE OF THE WORLD HEALTH ORGANIZATION AND UNITED NATIONS OFFICE ON DRUGS AND CRIME
THE EVOLVING ROLE OF INTERNATIONAL MEDICAL ASSOCIATIONS
The Advocacy Role
International Dissemination of Information
International Accreditation of Specialists
Reaching Out to Colleagues From Developing Countries
Impact of Culture on Medical Practice
CONCLUSIONS
ACKNOWLEDGMENTS
SECTION 5 Special Issues in Addiction
CHAPTER 37 Prescription Medications: Nonmedical Use, Use Disorders, and Public Health Consequences
INTRODUCTION
HISTORICAL PERSPECTIVE ON THE SCHEDULING OF PRESCRIPTION DRUGS IN THE UNITED STATES
DEFINITIONS OF THE TERMS USED TO CLASSIFY SUBTYPES OF NONMEDICAL MEDICATION USE
EPIDEMIOLOGY OF NONMEDICAL USE OF PRESCRIPTION DRUGS
Comorbidity with Other Substances and with Psychiatric Illnesses
THE MAJOR CLASSES OF PRESCRIPTION DRUGS USED NONMEDICALLY
Opioids (Analgesics)
Stimulants
Sedatives–Hypnotics
EVIDENCE-BASED PREVENTION AND HARM REDUCTION AND POLICY APPROACHES
Prevention Programs
Prescriber Education
Prescription Drug Monitoring Programs
Abuse-Deterrent Formulations
Harm Reduction Policies
Naloxone
Needle and Syringe Services Programs
HIV Prevention and Treatment
Prescription Take-Back Programs
EVIDENCE-BASED TREATMENT FOR PRESCRIPTION DRUG USE DISORDERS
ONGOING RESEARCH
SUMMARY/CONCLUSIONS
CHAPTER 38 Special Issues in Treatment: Women
INTRODUCTION
EPIDEMIOLOGY
Gender Differences in Alcohol and Other Drug Use
Common Psychiatric Disorders in Women With Substance Use Disorder
MEDICAL CONSIDERATIONS
Alcohol
Prenatal Alcohol Exposure
Drugs
Interpersonal Violence
HIV/AIDS
PSYCHIATRIC DISORDERS
Anxiety Disorders
Mood Disorders
Eating Disorders
Borderline Personality Disorder
SPECIAL POPULATIONS
TREATMENT ISSUES
Management and Retention Issues
Treatment Outcomes
Physical and Sexual Abuse and Domestic Violence
Treatment Culture
Opioid-Addicted Pregnant Women
Women and the Criminal Justice System
CONCLUSIONS
CHAPTER 39 Traumatic Brain Injury and Substance Use Disorders
INTRODUCTION
DEFINITION OF TRAUMATIC BRAIN INJURY
Classification
Diagnosis of TBI
EPIDEMIOLOGY OF TBI
PREVALENCE OF SUD AND TBI
RISK FACTORS INFLUENCING CO-OCCURRENCE
TBI Increases Risk of Developing an SUD
Dopaminergic Neurocircuitry in Animal Models of TBI
Emerging Evidence for Dopaminergic Agonist Treatment for TBI
TBI-Related Neurobehavioral Risks of Developing Addiction
HARMS ASSOCIATED WITH CO-OCCURRENCE OF SUD AND TBI
Mortality
Violence
Neurocognitive Performance
Life Satisfaction and Vocation
Mood/Affect Impairment
Chronic Pain
ASSESSMENT OF CO-OCCURRING TBI AND SUD
FACTORS INFLUENCING RECOVERY FROM TBI
TREATMENT APPROACHES FOR TBI AND SUD
Cognitive Rehabilitation for TBI
Cognitive Rehabilitation Summary and New Directions
Pharmacological Interventions for SUD and TBI
Pharmacotherapy for SUD and TBI: Future Directions
CONCLUSIONS
CHAPTER 40 Military Sexual Trauma
BARRIERS TO REPORTING SEXUAL ASSAULT
MILITARY CULTURE
CLINICAL ISSUES
GETTING HELP AT THE VA
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 41 Alcohol, Prescription, and Other Drug Problems in Older Adults
INTRODUCTION
ALCOHOL USE GUIDELINES FOR OLDER ADULTS
SCOPE OF THE PROBLEM IN OLDER ADULTHOOD
Alcohol
ALCOHOL AND PRESCRIPTION MEDICATIONS
NONMEDICAL USE OF PRESCRIPTION MEDICATIONS
Opioids and Benzodiazepines
Illegal Drugs
Nicotine
Substance Use Disorder (SUD) Diagnostic Classifications and Older Adults
ISSUES UNIQUE TO OLDER ADULTS
Co-occurring Disorders in Older Adulthood
Comorbidity and Suicidality
Weighing the Positive and Negative Aspects of Alcohol Use
SCREENING AND DETECTION OF ALCOHOL AND NONMEDICAL USE OF PRESCRIPTION MEDICATIONS IN OLDER ADULTS
Screening Process
Screening Instruments
MAST-G and SMAST-G (Table 41-2)
AUDIT and AUDIT-C (Table 41-3)
Broad-Based Assessment
INTERVENTION STRATEGIES FOR OLDER ADULTS
Brief Alcohol Interventions
Formal Addiction Treatment in Older Adulthood
LIMITATIONS OF TREATMENT OUTCOME RESEARCH
Relapse Reduction
CONCLUSION
CHAPTER 42 Cultural Issues in Addiction Medicine
INTRODUCTION
CULTURAL DEFINITIONS RELATED TO SUBSTANCE USE
CULTURE AND PATTERNS OF SUBSTANCE USE
CULTURAL ASPECTS OF CLINICAL ASSESSMENT
Taking a Cultural History
SUBSTANCE AND GAMBLING-SPECIFIC HISTORY
ADDICTION AND PATIENTS’ CULTURAL FUNCTION
CULTURE, TREATMENT, AND RECOVERY
Addiction, Recovery, and the Intimate Social Network
Cultural Recovery in Substance Use Disorders
Evolution of Sociocultural Interventions
Culture-Specific Treatment
CONCLUSIONS
CHAPTER 43 College Student Drinking
PREVALENCE AND CONSEQUENCES
Drinking Rates and Disorders Among College Students
Alcohol-Related Problems and Consequences
Risk Factors for College Student Drinking
Individual and Environmental Risk Factors
PREVENTION STRATEGIES AND INTERVENTIONS
College Drinking Prevention Strategies
Individually Focused Interventions
Structural Interventions
CONCLUSIONS AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
CHAPTER 44 Understanding “Behavioral Addiction”
INTRODUCTION
IMPULSE CONTROL DISORDERS OR “BEHAVIORAL ADDICTION”?
PATHOLOGICAL GAMBLING OR GAMBLING DISORDER (SEE ALSO CHAPTER 45)
A Nonsubstance Addiction?
Neurocognition
Delay Discounting
Neurocircuitry
Neurostructure
Neurochemistry
Conclusion
BINGE EATING DISORDER
Epidemiology
Conceptualization and Treatment
The Biology of Eating Behaviors
Conclusion
COMPULSIVE SEXUAL BEHAVIOR
Epidemiology
Defining the Disorder
Neurocircuitry
Neurostructure
Neurochemistry
Conclusion
PROBLEMATIC INTERNET USE
Epidemiology
Neurocircuitry
Neurostructure
Neurochemistry
Genetic Polymorphisms in PIU
Gender Differences
Conclusion
PROBLEMATIC VIDEO-GAME PLAYING/INTERNET GAMING DISORDER
Epidemiology
Neurocircuitry and Structure
Neurochemistry
Genetic Polymorphisms in IGD
Gender Differences
Conclusion
COMPULSIVE BUYING DISORDER
Neurocircuitry
Neurochemistry
Opioid Antagonists
Conclusion
CONCLUSION
CHAPTER 45 Gambling Disorder: Clinical Characteristics and Treatment
EPIDEMIOLOGY
ASSESSMENT
Clinical Characteristics
Functional Impairment, Quality of Life, and Legal Difficulties
Psychiatric Comorbidity
Family History
TREATMENT
Psychologically Based Treatments
Assessment of Psychologically Based Treatments
Pharmacotherapy
Assessment of Pharmacotherapy
Treatment Recommendations
ACKNOWLEDGMENTS
CHAPTER 46 Problematic Sexual Behaviors and “Sexual Addiction”
HISTORICAL, LEGAL, AND CULTURAL CONTEXTS
HIGH-VOLUME SEXUAL BEHAVIORS: HYPERSEXUAL DISORDER AND SEXUAL ADDICTION
Etiology of HVSB
Neurobiology of HVSB
Psychiatric Comorbidity
Depression
Anxiety
Attention Deficit Hyperactivity Disorder
Personality Disorders
PARAPHILIAS AND PARAPHILIC DISORDERS
Definitions and Diagnosis
Etiology, Development, and Prevalence of Paraphilic Disorders
PEDOPHILIA AND SEX WITH MINORS
COMPULSIVE SEX IN COMBINATION WITH SUBSTANCE USE
Special Populations: PSB Among MSM
ASSESSMENT AND TREATMENT OF PROBLEMATIC SEXUAL BEHAVIORS
Assessment
Treatment Approaches
Contingency Management
Behavior Therapies
Cognitive Behavioral Therapy
12-Step and Self-Help Groups
Psychoanalytic Approaches
PHARMACOTHERAPY STRATEGIES
Antidepressants
Selective Serotonin Reuptake Inhibitors
Opioid Antagonists
Hormonal Therapies for Paraphilic Disorders
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 47 Microprocessor-Based Disorders
INTRODUCTION
HISTORICAL PERSPECTIVE
Social Adaptation to Technological Change
DIAGNOSTIC DILEMMAS
Neuroimaging and Neuropsychological Correlates
ASSESSMENT
EPIDEMIOLOGY AND COMORBIDITY
INTERNET CHARACTERISTICS
TREATMENT MODEL
Theory of Change
TREATMENT PLANNING
Evaluation—Diagnosis
INDICATIONS FOR TREATMENT
Mortality
Morbidity
PRETREATMENT ISSUES
Motivation—Rationale for Choice of Treatment
Treatment and Technique
RELEVANT TREATMENT RESEARCH
Psychologically Based Treatments
Pharmacotherapy and Psychologically Based Treatments
SUMMARY AND CONCLUSIONS
CHAPTER 48 Behavioral Syndromes to Consider as Forms of “Addiction”
INTRODUCTION
COMPULSIVE BUYING DISORDER
EXCESSIVE TANNING
KLEPTOMANIA
SHARED FEATURES OF BEHAVIORAL AND SUBSTANCE ADDICTIONS
CO-OCCURRENCE OF SUBSTANCE USE AND BEHAVIORAL ADDICTIONS
DIAGNOSTIC CHALLENGES
TREATMENT MODELS
CONCLUSION
CHAPTER 49 Physician Health Programs and Addiction Among Physicians
INTRODUCTION
PREVALENCE
CHARACTERISTICS OF PHYSICIANS WITH ADDICTION
Age and Gender
Specialty
DRUGS USED
Alcohol
Tobacco
Opioids
Cocaine
Amphetamine
Benzodiazepines
Propofol
Cannabis
Other Drugs
RISK FACTORS
Genetics
Personality
Drug Access
Biologic Effect of the Drug of Choice
ADDICTION COMORBIDITY
Thought and Mood Disorders
Pain
Posttraumatic Stress Disorder
THEORIES OF ADDICTION AMONG PHYSICIANS
IDENTIFICATION, INTERVENTION, AND ASSESSMENT
Identification
Modes of Intervention
Assessment
TREATMENT
Clinical Considerations in Treating Addicted Physician–Patients
Characteristics of the Treatment Setting
Physician Health Programs
Treatment Outcome Data
CONTROVERSIES
Conflicts between Privacy and Public Safety
Complaints about Coercion and Control
Is Monitored Recovery the Same as Self-Guided Recovery?
Should Physicians Receiving Opioid Agonist Treatment Return to Practice?
Re-entry of Physicians Diagnosed With Opioid Use Disorders
What Happens when a Physician Relapses?
CONCLUSION
SECTION 6 Management of Intoxication and Withdrawal
CHAPTER 50 Management of Intoxication and Withdrawal: General Principles
INTRODUCTION
INTOXICATION STATES
Identification and Management of Intoxication
RECOGNIZING THE IMPACT OF EVER CHANGING DRUG TRENDS
WITHDRAWAL STATES
Goals of Detoxification
General Principles of Management
Pharmacological Management
Detoxification Settings
Inpatient Detoxification
Outpatient Detoxification
Considerations in Selecting a Setting
Use of the ASAM Criteria
Relapse
SPECIAL POPULATIONS
Pregnant and Nursing Women
Persons Who Are HIV Positive
Patients With Other Medical Conditions
Cardiovascular Disorders
Hepatic or Renal Disorders
Chronic Pain
Patients With Psychiatric Comorbidities
Adolescents
Older Adults
Persons in Criminal Justice Settings
CONCLUSIONS
CHAPTER 51 Management of Alcohol Intoxication and Withdrawal
ALCOHOL INTOXICATION
Clinical Picture
Management
HANGOVER
ALCOHOL WITHDRAWAL
Clinical Presentation
Hallucinations
Pathophysiology
Genetics
Role of Alcohol Withdrawal in Diagnostic Classification
MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROMES
General Principles
Pharmacological Management of Uncomplicated Withdrawal Syndrome
Management of the Patient After a Withdrawal Seizure
Management of the Patient With Delirium
COMMON TREATMENT ISSUES
Location of Treatment Services
Patients Admitted for Medical/Surgical Treatment
Alcohol Withdrawal in U.S. Jails
“Social Setting” Withdrawal Management
CONCLUSIONS
CHAPTER 52 Management of Sedative–Hypnotic Intoxication and Withdrawal
INTRODUCTION
SEDATIVE–HYPNOTIC INTOXICATION AND OVERDOSE
Clinical Picture
Management
SEDATIVE–HYPNOTIC WITHDRAWAL
Overview
Signs and Symptoms of Discontinuation
Benzodiazepine Discontinuation
Pharmacological Characteristics Affecting Withdrawal
Host Factors Affecting Withdrawal
PATIENT EVALUATION AND MANAGEMENT
Evaluation and Assessment
Management
Appropriate Clinical Setting
Adjunctive Withdrawal Management Measures
Prolonged Benzodiazepine Withdrawal
COMMON TREATMENT ISSUES
Prevention
SUMMARY
CHAPTER 53 Management of Opioid Intoxication and Withdrawal
INTRODUCTION
OPIOID INTOXICATION AND OVERDOSE
Clinical Picture
Diagnosis
Management
Pharmacological Therapies
Follow-Up Care
OPIOID WITHDRAWAL
Acute Withdrawal
Chronic Physiological Dependence and Protracted Abstinence
Clinical Picture
Diagnosis
Management
Pharmacological Therapies for Opioid Withdrawal
Full Opioid Agonists
Other Opioid Agonists
Alpha-2 Adrenergic Agents
Other Agents
Follow-Up Care
CONCLUSIONS
CHAPTER 54 Management of Stimulant, Hallucinogen, Marijuana, Phencyclidine, and Club Drug Intoxication and Withdrawal
INTRODUCTION
STIMULANTS
Stimulant Intoxication
Stimulant Withdrawal
HALLUCINOGENS
Hallucinogen Intoxication
Hallucinogen Withdrawal
MARIJUANA
Marijuana Intoxication
Marijuana Withdrawal
DISSOCIATIVE ANESTHETICS
Phencyclidine, Ketamine, and Dextromethorphan Intoxication
Dissociative Anesthetic Withdrawal
Prolonged Psychiatric Sequelae
INHALANTS
Inhalant Intoxication
Inhalant Withdrawal
CLUB DRUGS
MDMA (“ECSTASY”)
MDMA Intoxication
MDMA Withdrawal
GAMMA HYDROXYBUTYRATE
GHB Intoxication
GHB Withdrawal
MISUSE OF HERBS
Intoxication
Management of Psychological, Behavioral, and Medical Effects
Withdrawal
FLUNITRAZEPAM
Flunitrazepam Intoxication
Flunitrazepam Withdrawal
SEROTONIN SYNDROME
WITHDRAWAL FROM MULTIPLE DRUGS
Multiple Sedative–Hypnotics
Sedative–Hypnotics With Other Drugs
POPULATION-SPECIFIC CONSIDERATIONS
Neonates
Older Adults
Adolescents
Women
ACKNOWLEDGMENTS
SECTION 7 Pharmacological Interventions and Other Somatic Therapies
CHAPTER 55 Pharmacological Interventions for Alcohol Use Disorder
INTRODUCTION
MEDICATIONS USED TO REDUCE OR STOP DRINKING
Alcohol-Sensitizing Agents
Medications That Directly Reduce Alcohol Consumption
Acamprosate
Studies Comparing Acamprosate With Naltrexone and the Two Medications Combined
Anticonvulsants
Baclofen
Serotonergic Agents in Alcohol Use Disorder Subtypes
MEDICATIONS TO TREAT CO-OCCURRING PSYCHIATRIC SYMPTOMS OR DISORDERS IN PATIENTS WITH ALCOHOL USE DISORDER
Antidepressant Treatment of Unipolar Depression and Alcohol Use Disorder
Mood Stabilizer Treatment of Bipolar Disorder and Alcohol Use Disorder
Treatment of Co-occurring Anxiety Disorders and Alcohol Use Disorder
THE USE OF PHARMACOTHERAPIES IN THE TREATMENT OF ALCOHOL USE DISORDER
SUMMARY AND CONCLUSIONS
CHAPTER 56 Pharmacological Interventions for Sedative–Hypnotic Use Disorder
INTRODUCTION
PHARMACOLOGY
DEFINITIONS
USE OF SEDATIVE–HYPNOTIC MEDICATIONS
INDICATIONS FOR PHARMACOLOGICAL INTERVENTIONS
MANAGEMENT OF INTOXICATION AND OVERDOSE
WITHDRAWAL
MANAGEMENT OF WITHDRAWAL
Benzodiazepine Taper
Anticonvulsants
Phenobarbital
Flumazenil
Protracted Withdrawal Symptoms
TREATMENT SETTING
TREATMENT OF CO-OCCURRING DISORDERS
CONCLUSIONS AND FUTURE DIRECTIONS
CHAPTER 57 Pharmacological and Psychosocial Treatment for Opioid Use Disorder
INTRODUCTION
HISTORY AND CONTEXT OF OPIOID AGONIST TREATMENT
MODERN HISTORICAL UNDERSTANDINGS OF OUD
OVERVIEW OF PHARMACOLOGIC INTERVENTIONS
Opioid Antagonists
Opioid Full and Partial Agonists
Nonopioids: α-Adrenergic Agents
ABSTINENCE SYNDROMES AND MEDICALLY SUPERVISED WITHDRAWAL
Opioid Agonists and Partial Agonists
Nonopioid Medication Treatments
Lofexidine and Other α2-Adrenergic Agonists
Medication Combinations, Rapid and Ultrarapid Opioid Withdrawal
LONG-TERM TREATMENTS FOR OUD
Clinical Issues in Ongoing Pharmacotherapy
Treatment Using Methadone
Buprenorphine Treatment
SPECIAL ISSUES IN ONGOING MEDICATION TREATMENT
Comparative Efficacy of Buprenorphine Versus Methadone: Choice Between Methadone and Buprenorphine
PATIENTS WITH CO-OCCURRING PSYCHIATRIC DISORDERS
PSYCHOSOCIAL INTERVENTIONS
OVERSIGHT AND REGULATORY CHALLENGES
CHAPTER 58 Special Issues in Office-Based Opioid Treatment
INTRODUCTION
EPIDEMIOLOGICAL AND REGULATORY ISSUES
RESEARCH ISSUES
Research Related to Stable, Long-Term Patients in Office-Based Practice
Research Related to Patients Entering Directly into Office-Based Practice
CLINICAL ISSUES
CONCLUSIONS
CHAPTER 59 Pharmacological Treatment of Stimulant Use Disorders
INTRODUCTION
COCAINE USE DISORDER
Goals of Treatment
Pharmacological Mechanisms
CHOICE OF MEDICATION
Antidepressants
Dopamine Agonists (Antiparkinson Agents)
Serotonergic Agents
Cholinergic Agents
Opioid Receptor Ligands
Stimulants
Antipsychotics
Anticonvulsants
Nutritional Supplements and Herbal Products
Calcium Channel Blockers
Other Medications
Medication Combinations
Other Physical Treatments
AMPHETAMINE USE DISORDER
SPECIAL TREATMENT SITUATIONS
Mixed Substance Use Disorders
Psychiatric Comorbidities
Medical Comorbidities
Gender-Specific Issues
Age
FUTURE PROSPECTS
CONCLUSIONS
CHAPTER 60 Pharmacological Interventions for Tobacco Use Disorder
NEUROBIOLOGY OF TOBACCO USE DISORDER
MEASURING NICOTINE EXPOSURE
NICOTINE REPLACEMENT THERAPY
Nicotine Gum
Nicotine Lozenge
Nicotine Nasal Spray
Nicotine Inhaler
Nicotine Patch
NONNICOTINE MEDICATIONS
Bupropion Sustained Release
Varenicline
Nortriptyline
Clonidine
COMBINATION PHARMACOTHERAPY
Cigarette Smoking Reduction
GENETICS AND ACHIEVING SMOKING ABSTINENCE
ELECTRONIC NICOTINE DELIVERY SYSTEMS
TREATMENT OF SMOKELESS TOBACCO USE
POSTCESSATION WEIGHT GAIN
CLINICAL DECISIONS ABOUT PHARMACOTHERAPY
Duration of Pharmacotherapy
Tapering of Pharmacotherapy
CONCLUSIONS
CHAPTER 61 Pharmacological Interventions for Other Drugs and Multiple Drug Use Disorders
INTRODUCTION
CANNABIS
ANABOLIC STEROIDS
PHENCYCLIDINE AND KETAMINE
PCP in Combination with Cocaine or Marijuana
INHALANTS
NICOTINE WITH OTHER DRUGS
Tobacco and Alcohol
Tobacco and Opioids
Tobacco and Cocaine
OPIOIDS WITH OTHER DRUGS
Opioids and Alcohol
Opioids and Cocaine
HALLUCINOGENS
CONCLUSIONS
CHAPTER 62 Neuromodulation for Addiction-Related Disorders
SECTION 8 Psychologically Based Interventions
CHAPTER 63 Enhancing Motivation to Change
INTRODUCTION
THE STAGES OF CHANGE
USING THE STAGES OF CHANGE MODEL TO CATALYZE MOTIVATION
Recruitment
Retention
Progress
Process
Outcomes
CONCLUSIONS
CHAPTER 64 Group Therapies
INTRODUCTION
GOALS OF GROUP THERAPIES
ORGANIZATION OF GROUP THERAPIES
Orienting Patients to Groups
Types of Group Therapies
Format of Group Sessions
Interventions of Group Leaders
EMPIRICAL VALIDATION OF GROUP THERAPIES
Adherence to Group Sessions and Treatment Dropout
Limitations of Research
GROUP THERAPIES FOR CO-OCCURRING DISORDERS
The Need for Physician Input and Support
SURVEY OF GROUP THERAPISTS
Counselor Training
Counselor Supervision
Counselor Satisfaction
LIMITATIONS OF GROUP THERAPIES
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 65 Individual Treatment
INTRODUCTION
HISTORY OF PSYCHOTHERAPY FOR SUBSTANCE USE DISORDERS
DEVELOPMENT OF BEHAVIORAL THERAPIES FOR SUBSTANCE USE DISORDERS: THE TECHNOLOGY MODEL
COMMON ELEMENTS OF EFFECTIVE BEHAVIORAL THERAPIES
Focusing Directly on Substance Use
Enhancing Motivation to Reduce/Stop Substance Use and Adhere to a Treatment Plan
Coping Skills to Avoid Substance Use and Change Lifestyle
Changing Reinforcement Contingencies
Managing Painful Effects and Stress
Improving Interpersonal Functioning and Social Support
Fostering the Treatment Alliance
OVERVIEW OF EVIDENCE-BASED PSYCHOTHERAPIES FOR SUBSTANCE USE DISORDERS
Motivational Interviewing and Motivational Enhancement Therapy
Brief Advice
Supportive–Expressive Therapy
Cognitive–Behavioral Approaches: Relapse Prevention and Coping Skills Therapies
Community Reinforcement Approach
Contingency Management
Individual Drug Counseling
Twelve-Step Facilitation
Medical Management
ROLE OF SIGNIFICANT OTHERS IN TREATMENT OF SUBSTANCE USE DISORDERS
Network Therapy
Community Reinforcement and Family Training Model
Family Therapies
COMBINING INDIVIDUAL PSYCHOTHERAPY WITH OTHER MODALITIES: GROUP THERAPY AND MEDICATIONS
Group Therapy
Individual Therapy and Medications for Substance Use Disorders
DIFFERENTIAL THERAPEUTICS: HOW TO MATCH PATIENTS WITH THERAPIES
VIRTUAL THERAPY AND COMPUTER-DELIVERED TECHNOLOGY-BASED INTERVENTIONS
TECHNOLOGY TRANSFER: HOW TO EFFECTIVELY TRAIN CLINICIANS TO DELIVER EVIDENCE-BASED PSYCHOTHERAPIES
DEDICATION
CHAPTER 66 Contingency Management and the Community Reinforcement Approach
HISTORICAL PERSPECTIVE
TREATMENT MODEL
TREATMENT PLANNING
PRETREATMENT ISSUES
Motivation
Rationale for Choice of Treatment
Selection and Preparation of Patients
Therapist Characteristics
TREATMENT AND TECHNIQUE
Contingency Management
Community Reinforcement Approach
EMPIRICAL SUPPORT
Community Reinforcement Approach + Vouchers
Contingency Management Interventions
Community Reinforcement Approach
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 67 Behavioral Interventions for Nicotine/Tobacco Use Disorder
INTRODUCTION
RELEVANCE FOR ADDICTION TREATMENT
CHAPTER OVERVIEW
HISTORY OF TREATMENTS FOR NICOTINE/TOBACCO USE DISORDER
TREATMENT MODEL
Theory of Change
TREATMENT PLANNING
TREATMENT AND TECHNIQUE
Motivating Smokers to Quit
Rationale for the Choice of Behavioral Treatments
Brief Clinical Interventions
CESSATION STAGE INTERVENTIONS
Self-Management
SPECIAL POPULATIONS
Racial and Ethnic Minorities
Heavy Alcohol Use
Psychiatric Patients
Behavioral Approaches and Comorbid Mood Problems
NOVEL TREATMENT APPROACH IN DEVELOPMENT
SUMMARY AND CONCLUSIONS
CHAPTER 68 Network Therapy
INTRODUCTION
THE NETWORK THERAPY TECHNIQUE
Key Elements
COGNITIVE–BEHAVIORAL THERAPY AND SOCIAL SUPPORT
Cognitive–Behavioral Therapy
Social Support
Contrast With Other Approaches
Community Reinforcement
Initial Encounter: Starting a Social Network
Defining the Network’s Membership
Defining the Network’s Task
The Use of Alcoholics Anonymous
Use of Pharmacotherapy in the Network Format
Format for Medication Observation by the Network
Meeting Arrangements
Adapting Individual Therapy to the Network Treatment
A LONGER COURSE
RESEARCH ON NETWORK THERAPY
An Office-Based Clinical Trial
Treatment by Psychiatry Residents
Treatment by Addiction Counselors
Use of the Internet
Network Therapy in Buprenorphine Maintenance
ADAPTATIONS OF NETWORK THERAPY TREATMENT
PRINCIPLES OF NETWORK TREATMENT
Start a Network As soon as Possible
Manage the Network With Care
Keep the Network’s Agenda Focused
Make Use of Alcoholics Anonymous and Other Self-Help Groups
CHAPTER 69 Therapeutic Communities and Modified Therapeutic Communities for Co-Occurring Mental and Substance Use Disorders
INTRODUCTION
Part I: Traditional TCS1
THE TC PERSPECTIVE
View of the Disorder
View of the Person
View of Recovery
Motivation
Self-help and Mutual Self-help
Social Learning
View of Right Living
THE TC APPROACH: COMMUNITY-AS-METHOD
THE TC PROGRAM MODEL
TC Structure/Social Organization
Work as Education and Therapy
Peers as Role Models
Staff as Rational Authorities
THERAPEUTIC COMMUNITY METHODS
Therapeutic–Educative Activities (Groups-Counseling)
Community Enhancement Activities (Meetings)
Community and Clinical Management Elements
Disciplinary Sanctions
THE PROGRAM STAGES AND PHASES
Stage 1: Orientation–Induction (0-60 Days)
Stage 2: Primary Treatment (2-12 Months)
Stage 3: Reentry (13-24 Months)
Graduation
Aftercare
CRITERIA FOR RESIDENTIAL TC TREATMENT
RESEARCH: THE EFFECTIVENESS OF TRADITIONAL THERAPEUTIC COMMUNITIES
THE EVOLUTION OF THE TC: MODIFICATIONS AND APPLICATIONS
CURRENT APPLICATIONS TO SPECIAL POPULATIONS
THE TC WORLDWIDE
THE TC IN HUMAN SERVICES
PART II: MODIFIED THERAPEUTIC COMMUNITY FOR PERSONS WITH CO-OCCURRING MENTAL AND SUBSTANCE USE DISORDERS
DESCRIPTION OF THE MODIFIED TC PROGRAM
TC Principles and Methods
THE TC STAGE AND PHASE TREATMENT PROCESS FOR CO-OCCURRING DISORDERS
OTHER MODIFICATIONS
INTERVENTIONS
OUTCOMES
CONTINUITY OF CARE
Rationale
MTC Residential Aftercare Models
Modified TC Outpatient Models
THE MEDICALLY INTEGRATED THERAPEUTIC COMMUNITY
SUMMARY
ACKNOWLEDGEMENTS
CHAPTER 70 Aversion Therapies
AVERSION THERAPY AS PART OF A MULTIMODALITY TREATMENT PROGRAM
PRINCIPLES OF CONDITIONING AND TASTE AVERSION
USES OF AVERSION THERAPY
Aversion Therapy for Alcohol Addiction
Aversion Therapy as a Treatment for Tobacco/nicotine Use Disorder
Aversion Therapy for Cannabis Use Disorder
Aversion Therapy for Stimulant Use Disorder (Cocaine and Methamphetamine)
Aversion Therapy for Opioid Use Disorder (Heroin and Prescription Opioids)
Use of Reinforcement (Booster) Aversion Treatments
Use of Support Programs and 12-Step Meetings After Receiving Aversion Therapy
EFFECT OF AVERSION ON CRAVING FOR ALCOHOL
FUNCTIONAL MRI STUDIES OF SUBSTANCE USE DISORDERS AND AVERSION AND CRAVING
EFFECT OF AVERSION ON COCAINE CRAVING
DETERMINANTS OF RELAPSE AFTER AVERSION TREATMENT
SAFETY OF AVERSION THERAPY
AVERSION THERAPY AS PART OF ESTABLISHED CARE FOR SUBSTANCE USE DISORDERS
CRITICISMS OF AVERSION THERAPY
NEED FOR FURTHER RESEARCH
ACKNOWLEDGMENT AND DEDICATION
CHAPTER 71 Family Involvement in Addiction, Treatment, and Recovery
INTRODUCTION
THE IMPORTANCE OF FAMILY IN ADDICTION
THE FAMILY WITH AN ADDICTED MEMBER
FAMILY CONSEQUENCES OF ADDICTION
FAMILY ADJUSTMENT TO ADDICTION AND RECOVERY
THE PHYSICIAN’S ROLE WITH ADDICTED FAMILIES
Screening
Identifying Family Consequences of Addiction
Identifying the Hidden Benefits of Addiction to Family Functioning
Working With the Family to Confront and Motivate the Addicted Individual(s) to Seek Treatment When Needed
Referring for Family Oriented Treatment and Support
Addressing Enabling Behaviors
FAMILY THERAPY FOR ADDICTION
Approaches for Adults
Approaches for Families with Troubled Adolescents
Approaches for Older Adults
Approaches for Military Members and Veterans
Approaches for Pregnant Women
SUMMARY
CHAPTER 72 Twelve-Step Facilitation Approaches
INTRODUCTION
HISTORICAL PERSPECTIVE
TREATMENT MODEL
THEORY OF CHANGE
TREATMENT PLANNING AND EVALUATION
INDICATIONS FOR TREATMENT
PRETREATMENT ISSUES
Motivation
Therapist Characteristics
RELEVANT RESEARCH
SUMMARY AND CONCLUSIONS
ACKNOWLEDGMENT
CHAPTER 73 Relapse Prevention: Clinical Models and Intervention Strategies
INTRODUCTION
LAPSE, RELAPSE, AND RECOVERY
TREATMENT OUTCOMES AND RELAPSE RATES
EFFECTIVENESS AND EFFICACY OF RELAPSE PREVENTION
RELAPSE REPLICATION AND EXTENSION PROJECT
DETERMINANTS OF RELAPSE
Intrapersonal Determinants
Interpersonal Determinants
MODELS OF RELAPSE PREVENTION
The Cognitive–Behavioral Model of Relapse
The Cognitive–Behavioral Model of Relapse, Revised
Clinical Relapse Prevention Interventions to Reduce Lapse and Relapse Risk
RELAPSE PREVENTION FOR CO-OCCURRING DISORDERS
CONCLUSIONS
CHAPTER 74 Digital Health Interventions for Substance Use Disorders: The State of the Science
DIGITAL HEALTH INTERVENTIONS FOR SUBSTANCE USE DISORDERS: THE STATE OF THE SCIENCE
Digital Health Interventions for Substance Use Disorders
DIGITAL THERAPEUTICS FOR SPECIFIC SUBSTANCE USE DISORDERS
Alcohol
Cannabis
Cocaine
DIGITAL THERAPEUTICS FOR DIVERSE SAMPLES WITH SUBSTANCE USE DISORDERS
Conclusions and Future Opportunities
ACKNOWLEDGMENTS
DISCLOSURE
CHAPTER 75 Medical Management Techniques and Collaborative Care: Integrating Behavioral with Pharmacological Interventions in Addiction Treatment
INTRODUCTION
OVERVIEW OF ISSUES AND APPROACHES
Clinical Skills Any Clinician Should Use
Behavioral Therapies in the Context of Withdrawal Management
Medication Adherence
Medical Management
Strategies to Integrate Medication Treatment and Behavioral Therapies
COLLABORATIVE CARE WITH COUNSELORS AND PSYCHOTHERAPISTS
Counselors
Licensed Providers
Collaboration with Psychotherapists in the Community
Pharmacotherapy Support from Nonphysicians
Collaborating to Achieve Patients’ Treatment Adherence
SECTION 9 Mutual Help, Twelve-Step, and Other Recovery Programs
CHAPTER 76 Twelve-Step Programs in Addiction Recovery
INTRODUCTION
ALCOHOLICS ANONYMOUS
The Program
Sponsorship
Predecessors to Alcoholics Anonymous
The Birth of Alcoholics Anonymous
The Growth of Alcoholics Anonymous
OTHER 12-STEP PROGRAMS
Narcotics Anonymous
Cocaine Anonymous
Marijuana Anonymous
Nicotine Anonymous
Gamblers Anonymous
Al-Anon and Alateen
OTHER NON-12-STEP RECOVERY GROUPS
SMART Recovery
Women for Sobriety
Secular Organizations for Sobriety
PHYSICIAN FACILITATION OF 12-STEP PARTICIPATION
Practical Information and Advice for Your Patients
OUTCOME STUDIES (SEE CHAPTER 70 FOR MORE DETAILS)
WHY ARE 12-STEP PROGRAMS EFFECTIVE?
CONCLUSION
CHAPTER 77 Recent Research into Twelve-Step Programs
INTRODUCTION
UTILIZATION OF AA
Population Studies
Help-Seeking Populations
Mandated Populations
Patterns of Utilization of AA
Summary
FACTORS ASSOCIATED WITH SUCCESSFUL AFFILIATION WITH AA
Summary
AA AND POPULATION SUBGROUPS
Women
Cultural, Racial, and Ethnic Subgroups
Age-Specific Groups
Individuals With Coexisting Psychiatric Disorders
Gays and Lesbians
Summary
THE EFFECTIVENESS OF AA AND TREATMENTS BASED ON AA
Randomized Clinical Trials
Naturalistic Studies of Treatments Based on Twelve-Step Principles
AA Involvement and the Prediction of Treatment Outcomes
Engaging Patients With AA
Summary
MECHANISMS OF CHANGE IN AA
Active Ingredients
What Do the AA Active Ingredients Influence?
Summary
CASE STUDY AND RECOMMENDATIONS FOR PRIMARY CARE MEDICAL PRACTITIONERS
FUTURE DIRECTIONS
AA as a Single Entity
Understanding Utilization of and Affiliation With AA
Population Subgroups
Effectiveness of AA
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 78 Spirituality in the Recovery Process
WHAT IS SPIRITUALITY?
UNDERSTANDING THE PHENOMENON
AA AS A SPIRITUAL RECOVERY MOVEMENT
CONCEPTUALIZING ADDICTION AND RECOVERY
SPIRITUALITY AND RELIGIOUS EXPERIENCE
SPIRITUALLY GROUNDED RECOVERY IN AA
Spirituality Without Theism
AA IN THE PROFESSIONAL CONTEXT
SECTION 10 Medical Disorders and Complications of Addiction
CHAPTER 79 Medical and Surgical Complications of Addiction
INTRODUCTION
ROUTINE AND PREVENTIVE CARE
Medical History
Physical Examination
Tests
Preventive Counseling
Immunizations
Chemoprophylaxis
CARE DURING HOSPITALIZATION
Withdrawal
Pain
Comorbidities
MEDICAL CONSEQUENCES OF ALCOHOL, TOBACCO, AND OTHER DRUG USE
Alcohol
Tobacco
Opioids, Cocaine, and Other Drugs
CONSEQUENCES IN OLDER ADULTS
CONCLUSIONS
ACKNOWLEDGMENT
CHAPTER 80 Cardiovascular Consequences of Alcohol and Other Drug Use
INTRODUCTION
ALCOHOL
Direct Effects
Alcoholic Cardiomyopathy
Heart Failure
Hypertension
Atrial Fibrillation and Other Arrhythmias
Coronary Artery Disease and Stroke
NICOTINE
Electronic Cigarettes
COCAINE
OPIOIDS
AMPHETAMINES
CANNABIS
Synthetic Marijuana
CONCLUSION
CHAPTER 81 Liver Disorders Related to Alcohol and Other Drug Use
ALCOHOLIC LIVER DISEASE
Epidemiology
Risk Factors for Alcohol-Related Liver Disease
Cofactors for Alcoholic Liver Disease
Pathogenesis of ALD
Clinical Features of ALD
Diagnosis and Assessment of Severity of Alcoholic Liver Disease
Treatment of Alcoholic Liver Disease
VIRAL HEPATITIS
Hepatitis A
Hepatitis B
Hepatitis CVirus
Hepatitis C in Special Populations
Clinical Manifestations
Management Issues
Treatment of Special Groups
Hepatitis D
Hepatic Toxicity Associated With Other Drug Use
CHAPTER 82 Renal and Metabolic Disorders Related to Alcohol and Other Drug Use
INTRODUCTION
OVERVIEW OF NEPHROLOGY AND RENAL CLINICAL SYNDROMES
MEASUREMENT OF RENAL FUNCTION
ALCOHOL
Hepatorenal Syndrome
Toxic Alcohols
OPIOIDS/HEROIN
Nephrotic Syndromes Associated with Opioid Misuse
Nephritic–Nephrotic Syndromes Associated with Opioid Misuse
Nephritic Syndromes Associated with Opioid Misuse
COCAINE
Cocaine-Related Vasculitis
Acute Kidney Injury and Rhabdomyolysis Associated with Cocaine Use
Cocaine, Hypertension, and Renal Disease
Cocaine-Induced Thrombotic Microangiopathy–Hemolytic Uremic Syndrome
MDMA (“ECSTASY”)
AMPHETAMINES
BATH SALTS
INHALANTS
TOBACCO USE AND RENAL DISEASE
CANNABINOIDS
Other Possible Renal Complications of Drug Use
CONCLUSIONS
CHAPTER 83 Gastrointestinal Disorders Related to Alcohol and Other Drug Use
GASTROINTESTINAL PROBLEMS RELATED TO ALCOHOL
The Parotid Glands and Oral Cavity
Esophagus
Stomach
Pancreas
Small Intestine
Colon
Alcohol and Gastrointestinal Cancer
GASTROINTESTINAL SYMPTOMS ASSOCIATED WITH OTHER DRUGS
Opioids
Laxative Misuse
Misuse of Anticholinergics
Effects of Tobacco on Gastrointestinal Function
The “Body Packing” Syndrome
CHAPTER 84 Respiratory Tract Disorders and Selected Critical Care Considerations Related to Alcohol and Other Drug Use
RESPIRATORY FUNCTION
COMMON PULMONARY COMPLICATIONS
Respiratory Depression
Atelectasis
Aspiration Syndromes
Respiratory Infections
Respiratory Complications of Contaminants
Occupational Lung Disease
Respiratory Complications of Injected Drugs
Respiratory Complications of Inhaled Drugs
TOBACCO AND NICOTINE
Chronic Obstructive Pulmonary Disease: Chronic Bronchitis and Pulmonary Emphysema
Airway Reactivity
Interstitial Lung Disease
Pulmonary Hypertension and Cor Pulmonale
Pneumothorax
Hemoptysis
Lung Cancer
Hypersensitivity Pneumonitis
Lipoid Pneumonia
Water Pipes
Electronic Cigarettes
MARIJUANA
Chronic Obstructive Pulmonary Disease
Pathogen-Associated Complications
Lipoid Pneumonia
Hemp Worker’s Lung
COCAINE
Barotrauma
Upper Airway Complications and Hemoptysis
Bronchitis
Airway Burns
Bronchospasm
Diffuse Alveolar Hemorrhage
Pulmonary Edema
Pulmonary Vascular Disease and Infarction
Eosinophilic Hypersensitivity Pneumonitis (“Crack Lung”)
Cryptogenic Organizing Pneumonia
Interstitial Pulmonary Fibrosis
AMPHETAMINES AND OTHER STIMULANTS
Metabolic Acidosis and Respiratory Alkalosis
Barotrauma
Respiratory Depression
Pulmonary Edema
Pulmonary Hypertension
Bullous Emphysema
CAFFEINE
OPIOIDS
Bronchospasm
Pulmonary Edema
Sleep-Disordered Breathing
Hypersensitivity Pneumonitis
ALCOHOL
Acute Metabolic Acidosis and Respiratory Alkalosis
Chronic Respiratory Alkalosis
Asthma
Hepatic Hydrothorax
Pulmonary Restriction From Ascites
Hepatopulmonary Syndrome
Portopulmonary Hypertension
Acute Respiratory Distress Syndrome
SEDATIVE–HYPNOTICS
Overdose
Withdrawal Syndromes
Sleep-Disordered Breathing
VOLATILE SUBSTANCES
Methemoglobinemia
Metabolic Acidosis and Respiratory Alkalosis
Asthma
Tracheobronchitis
Asphyxiation
NITROUS OXIDE
ANABOLIC STEROIDS
CONCLUSIONS
CHAPTER 85 Neurological Disorders Related to Alcohol and Other Drug Use
INTRODUCTION
TRAUMA AND TRAUMATIC BRAIN INJURY
HEADACHE
Alcohol
Other Sedative–Hypnotic Agents (Barbiturates, Benzodiazepines)
Caffeine
Cocaine, Amphetamines, and MDMA (Ecstasy)
Tobacco and Nicotine
Heroin and Opioids
Hallucinogens (LSD, Psilocybin, Mescaline)
Cannabis and Synthetic Cannabinoids
Dissociative Anesthetics (Ketamine, PCP, and Dextromethorphan)
NEUROBEHAVIORAL AND COGNITIVE DISORDERS
Alcohol
Other Sedative–Hypnotic Agents (Barbiturates, Benzodiazepines)
Cocaine, Amphetamines, and MDMA (Ecstasy)
Cannabis and Synthetic Cannabinoids
Heroin and Opioids
Hallucinogens (LSD, Psilocybin, Mescaline)
Dissociative Anesthetics (Ketamine, PCP, Dextromethorphan)
Inhalants
SEIZURES
Alcohol
Other Sedative–Hypnotic Agents (Barbiturates, Benzodiazepines)
Cocaine, Amphetamines, and MDMA (Ecstasy)
Heroin and Opioids
Cannabis and Synthetic Cannabinoids
Dissociative Anesthetics (Ketamine, PCP, Dextromethorphan)
Hallucinogens (LSD, Psilocybin, Mescaline)
Inhalants
Other Substances
STROKE
Tobacco and Nicotine
Alcohol
Cocaine, Amphetamines, and MDMA (Ecstasy)
Heroin and Opioids
Cannabis and Synthetic Cannabinoids
Hallucinogens (LSD, Psilocybin, Mescaline)
Dissociative Anesthetics (Ketamine, PCP, Dextromethorphan)
Other Substances
NEUROMUSCULAR (NERVE, MUSCLE, AND SPINAL CORD) DISORDERS
Alcohol
Heroin and Opioids
Inhalants
Other Substances
MOVEMENT DISORDERS
Alcohol
Cocaine, Amphetamines, and MDMA
Heroin and Opioids
Tobacco and Nicotine
Cannabis and Synthetic Cannabinoids
Other Substances
NEUROLOGICAL COMPLICATIONS OF SUBSTANCE USE RESULTING FROM INFECTIONS
OTHER COMPLICATIONS
CHAPTER 86 Human Immunodeficiency Virus, Tuberculosis, and Other Infectious Diseases Related to Alcohol and Other Drug Use
INTRODUCTION
HOST DEFENSES
SKIN AND SOFT TISSUE INFECTIONS
GINGIVITIS
ENDOCARDITIS
Epidemiology and Pathogenesis
Clinical Presentation
Diagnosis
Treatment
Outcome and Prevention
NONCARDIAC VASCULAR INFECTIONS
Epidemiology and Pathogenesis
Clinical Presentation
Diagnosis
Treatment
RESPIRATORY INFECTIONS
Epidemiology and Pathogenesis
Pneumonia
Tuberculosis
HEPATIC AND GASTROINTESTINAL INFECTIONS
BONE AND JOINT INFECTIONS
Osteomyelitis
Septic Arthritis
NERVOUS SYSTEM INFECTIONS
EYE INFECTIONS
HUMAN IMMUNODEFICIENCY VIRUS AND ACQUIRED IMMUNODEFICIENCY SYNDROME
Epidemiology and Pathogenesis
Classification
Diagnosis
Treatment
Prevention
SEXUALLY TRANSMITTED DISEASES
CONCLUSIONS
CHAPTER 87 Sleep Disorders Related to Alcohol and Other Drug Use
INTRODUCTION
OVERVIEW OF SLEEP
Sleep Architecture
Sleep Rhythms
DISORDERS OF SLEEP
Specific Sleep Disorders
Extrinsic Factors
Medical and Psychiatric Factors
ALCOHOL AND SLEEP
Effect of Alcohol on Sleep in the Individual Without Alcohol Use Disorder
Effect of Alcohol on Sleep in the Individual With Alcohol Use Disorder
SPECIFIC SLEEP DISORDERS ASSOCIATED WITH ALCOHOL USE DISORDER
Alcohol and Sleep-Related Breathing Disorders
Alcohol and Periodic Limb Movements of Sleep
OTHER DRUGS AND SLEEP
Stimulants
Opioids
Nicotine
Marijuana
Benzodiazepines
Gabapentin
Clonidine
CLINICAL APPROACHES TO SLEEP DISORDERS
SPECIAL ISSUES IN SLEEP PHARMACOTHERAPY AND ADDICTION
Insomnia
Restless Legs Syndrome
CHAPTER 88 Traumatic Injuries Related to Alcohol and Other Drug Use: Epidemiology, Screening, and Prevention
INTRODUCTION
EPIDEMIOLOGY OF ALCOHOL- AND OTHER DRUG-RELATED INJURY
Overall Risks
Alcohol and Motor Vehicle Fatalities
Alcohol and Nonmotor Vehicle-Related Injuries
Relationship between Alcohol, Other Drugs, and Traumatic Injury
Alcohol, Other Drugs, and Trauma Patients Admitted to the Hospital
Cocaine Use and Traumatic Injuries
Drugs and Motor Vehicle Injury
SCREENING FOR UNHEALTHY ALCOHOL USE IN THE EMERGENCY DEPARTMENT
INTERVENTIONS WITH INJURED PATIENTS
INCORPORATING SCREENING AND BRIEF INTERVENTION INTO PRACTICE
EMERGING CONSIDERATIONS
Electronic Cigarette Use and Injuries
CONCLUSIONS
CHAPTER 89 Endocrine and Reproductive Disorders Related to Alcohol and Other Drug Use
INTRODUCTION
DISORDERS RELATED TO ALCOHOL
Hypoglycemia
Hyperglycemia
Reproductive Consequences
Bone Health Consequences
Other Endocrinological Consequences
DISORDERS RELATED TO TOBACCO
Disorders Related to Tobacco
Insulin Resistance and Dyslipidemia
Reproductive Function
Bone Health
Other Endocrinological Effects
Disorders Related to Opioid Use
Male Gonadal Function
Female Gonadal Function
Bone Health
Other Endocrine Effects
DISORDERS RELATED TO OTHER DRUGS
Marijuana
Cocaine
Amphetamines
Caffeine
Benzodiazepines
Barbiturates
Inhalants
Anabolic Steroids
Other Drugs
CONCLUSION
CHAPTER 90 Alcohol and Other Drug Use during Pregnancy: Management of the Mother and Child
APPROACH TO THE PREGNANT WOMAN
SCREENING
Laboratory Testing
Teratogenicity
NEONATAL ABSTINENCE SYNDROMES
TOBACCO
ALCOHOL AND SEDATIVES
Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure
OPIOIDS
Maternal Pharmacotherapy
Neonatal Withdrawal
CANNABIS
STIMULANTS
MATERNAL SUD TREATMENT
LABOR AND DELIVERY
BREAST-FEEDING
LEGAL ISSUES
POSTPARTUM CARE
CONCLUSIONS
CHAPTER 91 Perioperative Management of Patients with Alcohol- or Other Drug Use
INTRODUCTION
PERIOPERATIVE CARE OF THE PATIENT WITH UNHEALTHY ALCOHOL USE
Preoperative Evaluation
Management of Alcohol Withdrawal
Alcohol Use and Surgical Risk
Alcoholic Liver Disease
Management of Patients on Naltrexone (Opioid Antagonist) Pharmacotherapy
PERIOPERATIVE CARE OF THE PATIENT WITH AN OPIOID USE DISORDER
Preoperative Evaluation
Management of Opioid Withdrawal
Management of Patients on Medications That Treat Opioid Use Disorders (Also Known as “Medication Assisted Treatment”)
Management of Acute Pain in Patients on Opioid Agonist Therapy
Management of Acute Pain in Patients on Opioid Antagonist Therapy
PERIOPERATIVE CARE OF THE PATIENT WITH BENZODIAZEPINE USE DISORDER
PERIOPERATIVE CARE OF THE PATIENT WITH NICOTINE OR CANNABIS USE
PERIOPERATIVE CARE OF THE PATIENT WITH STIMULANT USE DISORDER
ORGAN TRANSPLANTATION IN PATIENTS WITH SUBSTANCE USE DISORDERS
CONCLUSIONS
SECTION 11 Co-Occurring Addiction and Psychiatric Disorders
CHAPTER 92 Substance-Induced Mental Disorders
INTRODUCTION
DIAGNOSIS OF SUBSTANCE-INDUCED MENTAL DISORDERS
PREVALENCE OF SUBSTANCE-INDUCED MENTAL DISORDERS
Prevalence of Substance-Induced Depressive Disorder and Anxiety Disorder
Prevalence of Substance-Induced Psychotic Disorders
Substance-Induced Bipolar and Related Disorder
Substance/Medication-Induced Obsessive–Compulsive and Related Disorders
Substance-Associated Suicidal Behavior
SPECIFIC SUBSTANCES: SUBSTANCE-INDUCED SYMPTOMS
Differential Diagnosis and Treatment
Substance-Induced Depressive and Anxiety Disorders
Substance-Induced Psychotic Disorders
Case 1
Case 2
Case 3
Case 4
CONCLUSIONS
CHAPTER 93 Co-occurring Mood and Substance Use Disorders
OVERVIEW AND DIAGNOSTIC CRITERIA
Significance
A Note on DSM-IV and DSM-5
DSM-5 Criteria for Depressive Disorders and Bipolar Disorders
Distinguishing Substance-Related Mood Symptoms From Mood Disorders
PREVALENCE AND PROGNOSTIC EFFECTS OF CO-OCCURRING MOOD AND SUBSTANCE USE DISORDERS
Mood Disorders Among Patients Seeking Treatment for Substance Use Disorders
Comorbidity of Mood and Substance Use Disorders in the General Population
Depression May Signal the Presence of ADHD, PTSD, or Other Disorders
Prognostic Effects
Primary Care and Psychiatric Populations
DIFFERENTIAL DIAGNOSIS
Etiological Relationships Between Mood and Substance Use Disorders
DSM-5 Primary Versus Substance-Induced Mood Disorders Versus Expected Effects of Substances (Intoxication and Withdrawal)
Diagnostic Methods and Predictive Validity
Diagnosing Bipolar Disorder in the Setting of Substance Use Disorder
Summary of Recommendations for Diagnosis of Co-occurring Mood Disorders
MANAGEMENT OF CO-OCCURRING MOOD AND SUBSTANCE USE DISORDERS
Depressive Disorders
Bipolar Disorder
SUMMARY AND FUTURE DIRECTIONS
ACKNOWLEDGMENTS
CHAPTER 94 Co-Occurring Substance Use and Anxiety Disorders
PREVALENCE
General Population
Addiction and Mental Health Treatment Populations
Primary Care Populations
SCREENING AND DIFFERENTIAL DIAGNOSIS
GENERAL TREATMENT CONSIDERATIONS
ALCOHOL AND ANXIETY
Generalized Anxiety Disorder
Social Anxiety Disorder
Obsessive–Compulsive Disorder
Panic Disorder
TOBACCO PRODUCTS AND ANXIETY DISORDERS
Differential Diagnosis
Panic Disorder
Social Anxiety Disorder
Generalized Anxiety Disorder
Obsessive–Compulsive Disorder
Tobacco/Nicotine Treatment
OPIOIDS AND ANXIETY DISORDERS
Diagnosis
Treatment
CANNABIS AND ANXIETY DISORDERS
STIMULANTS AND ANXIETY DISORDERS
Prevalence
Diagnosis
Treatment
CONCLUSIONS
CHAPTER 95 Co-Occurring Addiction and Psychotic Disorders
INTRODUCTION
DEFINITION OF PSYCHOTIC DISORDERS
PREVALENCE OF CO-OCCURRING ADDICTION AND PSYCHOTIC DISORDERS
Addiction Treatment Populations
Psychiatric Treatment Populations
Primary Care or Other Healthcare Settings
DIFFERENTIAL DIAGNOSIS
MANAGEMENT OF CO-OCCURRING PSYCHOSIS AND SUBSTANCE USE
Diagnostic Assessment
Management of Substance-Induced Psychotic Symptoms
Management of Schizophrenia With Comorbid Substance Use Disorder
LONGER-TERM MANAGEMENT
Management of Substance Use Disorders With Co-occurring Psychotic Disorders
Engaging Family and Other Support Networks
CONCLUSION
ACKNOWLEDGMENTS
CHAPTER 96 Co-occurring Substance Use Disorder and Attention Deficit Hyperactivity Disorder
INTRODUCTION
ETIOLOGY OF ADHD AND IMPLICATIONS FOR SUBSTANCE USE DISORDER VULNERABILITY
NEUROANATOMICAL ABNORMALITIES OBSERVED AMONG INDIVIDUALS WITH ADHD
EPIDEMIOLOGY OF ADHD AND SUBSTANCE USE DISORDERS
THE IMPACT OF HAVING ADHD ALONE AND WITH SUBSTANCE USE DISORDERS
POSSIBLE REASONS FOR LINKAGE OF ADHD AND SUBSTANCE USE DISORDERS
DIAGNOSIS OF ADHD
Utility of ADHD Screening Instruments in Substance-Using Populations
Use of Neuropsychological Testing to Confirm ADHD Diagnosis
Difficulties in Diagnosing Adult ADHD in Substance-Using Populations
Other Psychiatric Comorbidities
TREATMENT OF CO-OCCURRING ADHD AND SUD
Pharmacotherapeutic Options for Treatment of ADHD
Pharmacotherapy Selection for ADHD and Co-occurring SUD
Psychotherapeutic Interventions for ADHD and Substance Use Disorder
SUMMARY
CHAPTER 97 Co-occurring Personality Disorders and Addiction
INTRODUCTION
DEFINITIONS/CLASSIFICATION
EPIDEMIOLOGY
DIAGNOSIS: THEORETICAL ISSUES
Etiology of PDs
Co-occurring Models
Etiological Models
DIAGNOSIS: PRACTICAL ISSUES
Diagnostic Challenges
Psychiatric Illness Masquerading as PDs
Substance Use Masquerading as PDs
Medical Illness Masquerading as PDs
TREATMENT
Treatment Outcomes
General Treatment Strategies
Psychosocial Treatments
Integrated PD and SUD Psychosocial Treatments
Pharmacological Treatments
CONCLUSIONS
QUESTIONS
CHAPTER 98 Posttraumatic Stress Disorder and Substance Use Disorder Comorbidity
INTRODUCTION
PHENOMENOLOGY
EPIDEMIOLOGY
ETIOLOGICAL RELATIONSHIP BETWEEN PTSD AND SUBSTANCE USE DISORDERS
NEUROBIOLOGICAL FACTORS IN COMORBID PTSD AND SUBSTANCE USE DISORDERS
ASSESSMENT OF PTSD IN SUBSTANCE USE DISORDERS
Interviewer-Rated Assessment of PTSD
Self-report Assessment of PTSD
TREATMENT OF PTSD AND PTSD-SUD COMORBIDITY
CBT for PTSD
CONCLUDING COMMENTS
CHAPTER 99 Co-occurring Substance Use Disorders and Eating Disorders
INTRODUCTION
DEFINITIONS
Addiction
Feeding and Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Obesity
PREVALENCE OF EATING DISORDERS
General Population
Patients With Substance Use Disorders
Patients With Psychiatric Disorders
Primary Care or Other Healthcare Populations
DIFFERENTIAL DIAGNOSIS
Identifying Eating Disorders
Eating Disorders in Patients With Substance Use Disorders
SCREENING INSTRUMENTS
Yale Food Addiction Scale, Version 2.0
Eating Disorders Inventory, Third Edition
Eating Disorder Diagnostic Scale
Eating Disorder Examination Questionnaire
Bulimia Test—Revised
Binge Eating Scale
Night Eating Symptom Scale
Eating Behaviors Questionnaire
TREATMENT
Acute Treatment
Subacute Treatment
Long-Term Treatment
BIOLOGICAL MANAGEMENT
Acute Biological Management of AN
Subacute Biological Management of AN
Long-Term Biological Management of AN
Acute Biological Management of BN
Subacute Biological Management of BN
Long-Term Biological Management of BN
Biological Management of BED
Acute Biological Management of Obesity
Subacute Biological Management of Obesity
Long-Term Biological Management of Obesity
PSYCHOLOGICAL MANAGEMENT
Acute Psychological Management
Subacute Psychological Management
Long-Term Psychological Management
RECOVERY ISSUES
Co-occurring Substance Use Disorders
General Recovery Rates
Disordered Eating After Substance Use Disorder Treatment
AREAS FOR FURTHER STUDY
SUMMARY
SECTION 12 Pain and Addiction
CHAPTER 100 The Pathophysiology of Chronic Pain and Clinical Interfaces With Substance Use Disorder
INTRODUCTION
CHRONIC PAIN
Pain Anatomy and Physiology
Pain and Emotions
CLINICAL INTERFACE BETWEEN PAIN AND SUBSTANCE USE DISORDERS
Neurobiological Mechanisms of Substance Use Disorder
Analgesic Effects of Reinforcing Drugs
General Effects of Substance Use Disorders on Pain
Unique Effects of Opioid Use Disorder on Pain
Genetics and Opioid-Induced Hyperalgesia
CONCLUSIONS
ACKNOWLEDGMENT
CHAPTER 101 Psychological Issues in the Management of Pain
INTRODUCTION
Mind–Body Connection
PSYCHOLOGICAL MODULATION OF PAIN
Relationship Between Emotions and Pain
Emotional Distress
Attention and Pain Perception
Expectations and Goal Setting
Kinesiophobia and Fear–Avoidance Model of Pain
Cognitions and Coping
PSYCHOLOGICAL PROCESSES AND PAIN
Catastrophizing
Helplessness Versus Self-Efficacy
Locus of Control
Blame
CLASSIFICATION OF PAIN SYNDROMES
DSM-IV and DSM-5
ICD-10
Chronic Pain Syndrome
Malingering
THE ROLE OF THE ENVIRONMENT
Stress
Behavioral Contingencies
Secondary and Tertiary Gains and Disability
DEVELOPMENTAL ISSUES
ASSESSING PSYCHOLOGICAL COMORBIDITIES AND SUBSTANCE USE DISORDERS
BIOPSYCHOSOCIAL APPROACH TO THE TREATMENT OF PAIN
Exercise
Cognitive Behavioral Therapy for CNMP
Interdisciplinary Pain Programs
Barriers to Receiving Psychological Care
CONCLUSIONS
ACKNOWLEDGMENTS
CHAPTER 102 Rehabilitation Approaches to Pain Management
INTRODUCTION
ACTIVE PHYSICAL THERAPY
Physical Therapy Approaches to Stretching
Aquatic Therapy
Lumbar and Cervical Stabilization
Mechanical Diagnosis and Therapy (McKenzie Therapy)
OCCUPATIONAL THERAPY
Posture and Body Mechanics
Occupational Work Rehabilitation
PSYCHOLOGICAL INTERVENTIONS AS PART OF A PAIN REHABILITATION PLAN
THERAPEUTIC METHODS USED IN ACUTE AND CHRONIC PAIN CONDITIONS
Passive PT
Electrical Stimulation Therapy
Massage Therapy
CONCLUSION
CHAPTER 103 Nonopioid Pharmacotherapy of Pain
INTRODUCTION
NONOPIOID PHARMACOLOGICAL AGENTS
NONOPIOID ANALGESICS
Nonsteroidal Anti-Inflammatory Drugs
Adjuvant Analgesics
Topical Agents
Muscle Relaxants
SUMMARY
CHAPTER 104 Opioid Therapy of Pain
INTRODUCTION
HISTORICAL PERSPECTIVE ON OPIOIDS
PREVALENCE OF PAIN
PREVALENCE OF USE AND UNHEALTHY USE OF PRESCRIPTION OPIOIDS
POSITION OF OPIOIDS IN THE TREATMENT OF PAIN
SPECIAL ISSUES IN THE USE OF OPIOIDS
Physical Dependence
Tolerance
Hyperalgesia
Reward
Substance Use Disorders
Differential Diagnosis of Unhealthy Opioid Use
CLINICAL VARIABLES IN THE USE OF OPIOIDS
Medication Selection
Routes of Administration
Dose Titration and Scheduling
Opioid Side Effects and Management
PAIN MANAGEMENT IN PERSONS WITH ADDICTION
Acute Pain
Chronic Nonmalignant Pain
CONCLUSIONS
ACKNOWLEDGMENT
CHAPTER 105 Co-Occurring Pain and Addiction
INTRODUCTION
PROBLEMS OF COMORBIDITY
Reciprocal Vulnerability
Diagnostic Confounds
Treatment Impediments
EVOLVING GUIDANCE ON THE USE OF OPIOIDS IN THE TREATMENT OF CHRONIC PAIN
Monitoring for Unhealthy use and Opioid Use Disorder
GOURLAY AND HEIT (TABLE 105-1)
Diagnosis of Opioid Use Disorder in Chronic Pain
TREATING PAIN IN THE PRESENCE OF AN SUD
Acute Pain
Acute-on-Chronic Pain
Acute or Acute-on-Chronic Pain among Patients Receiving Opioid Agonist Therapy for OUD
Frequent Emergency Department Visits
Chronic Pain
Chronic Pain Among Patients on Opioid Agonist Therapy for OUD
Additional Rewarding Medications
TREATING ADDICTION IN THE PRESENCE OF PAIN
Agonist or Abstinence?
CONCLUSION
CHAPTER 106 Legal and Regulatory Considerations in Opioid Prescribing
INTRODUCTION
FEDERAL OPIOID REGULATIONS
STATE-CONTROLLED SUBSTANCE REGULATIONS
OPIOID PRESCRIBING WHEN FEDERAL AND STATE LAW CONFLICT
ROLES AND RECOMMENDATIONS FROM FEDERAL AGENCIES AND ORGANIZATIONS
The Drug Enforcement Administration (DEA)
The Food and Drug Administration (FDA) and Risk Evaluation and Mitigation Strategies (REMS)
PRESCRIBING GUIDELINES
Centers for Disease Control and Prevention (CDC) and the 2016 Opioid Prescribing Guidelines
Federation of State Medical Board Guidelines
Other Guidelines and Guideline Challenges
PRESCRIPTION DRUG MONITORING PROGRAMS
CONCLUSIONS
ACKNOWLEDGMENT
SECTION 13 Children and Adolescents
CHAPTER 107 Preventing Substance Use Among Children and Adolescents
INTRODUCTION
PREVALENCE RATES AND PROGRESSION OF USE
ETIOLOGY AND IMPLICATIONS FOR PREVENTION
Developmental Aspects
The Importance of Social Influences
Risk and Protective Factors
TYPES OF PREVENTIVE INTERVENTIONS
School-Based Prevention Approaches
Effectiveness of School-Based Prevention
Family-Based Prevention Approaches
Community-Based Prevention Approaches
SUMMARY AND CONCLUSIONS
NATIONAL CANNABIS USE TRENDS
CANNABIS AND THE ADOLESCENT BRAIN
EFFECTS OF LIBERALIZED CANNABIS POLICY ON YOUTH: WHAT DO WE KNOW?
SUMMARY
CHAPTER 108 Translational Neurobiology of Addiction from a Developmental Perspective
INTRODUCTION
BIOPSYCHOSOCIAL ANALYSIS
Prenatal Exposure
DEVELOPMENTAL HISTORY
SUBSTANCE USE HISTORY
PATIENT MEDICAL HISTORY
PATIENT PSYCHIATRIC HISTORY
FAMILY MEDICAL HISTORY
FAMILY PSYCHIATRIC HISTORY
SOCIAL HISTORY
FAMILY SOCIAL HISTORY
REVIEW OF SYSTEMS
MENTAL STATUS EXAM
STRESSORS
Stress, Drugs, Reward, and the HPA: Antireward System
Changes in the Brain Reward Circuitry in the Transition to an Addicted State
Role of Genes
STUDIES OF INHERITABILITY
Personality, Drug History, and Comorbidity
Substance Use History
Personality
Comorbidity
Mood and Conduct Disorders
Anxiety Disorders
Attention Deficit Hyperactivity Disorder
Exposure to Stimulants for Treatment of Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder
Learning Disorders
DEVELOPMENT OF THE ADOLESCENT BRAIN
DEVELOPMENT OF GOAL-DIRECTED BEHAVIOR
EVIDENCE FROM NEUROIMAGING STUDIES OF HUMAN DEVELOPMENT
Magnetic Resonance Imaging Studies of Human Development
Diffusion Tensor Imaging Studies of Human Brain Development
Functional Magnetic Resonance Imaging Studies of Behavioral and Brain Development
Why Would the Brain Be Programmed to Develop This Way?
BIOLOGICAL PREDISPOSITIONS, DEVELOPMENT, AND RISK
OVERLAP OF ADDICTION TO FOOD AND THE ADDICTION NETWORK
ROLE OF FAMILY AND PEERS DURING KEY DEVELOPMENTAL STAGES
Other Factors Influencing the HPA Axis
Effects of Early-Onset and Persistent Marijuana Use
CONCLUSIONS
QUESTIONS
CHAPTER 109 Screening and Brief Intervention for Adolescents
SCREENING FOR USE
SCREENING FOR RISKS AND PROBLEMS
SCREEN-SPECIFIC STRATEGIES
Physician Brief Advice
No Use: Praise and Encouragement
ASSESSMENT
Interviewing Adolescents
Substance Use History
Collateral History
Physical Exam
Laboratory Testing
REFERRAL TO TREATMENT
Brief Interventions
SUMMARY
CHAPTER 110 Assessing Adolescent Substance Use
PRINCIPLES OF ASSESSMENT
Screening
Comprehensive Assessment
DEVELOPMENTAL CONSIDERATIONS
Identifying Clinical Significance
SUD Criteria
Neurobiology
SELF-REPORT: VALIDITY AND ALTERNATIVES
Alternatives to Self-report
CLINICAL CONTENT
Course of SUDs
Psychosocial Factors
Impact on Treatment Outcome
INSTRUMENTATION
Screening Tools
Comparisons of Screens
Comprehensive Assessment Instruments
KEY POINTS
ACKNOWLEDGMENTS
CHAPTER 111 Placement Criteria and Strategies for Adolescent Treatment Matching
INTRODUCTION
DEVELOPMENTAL CONSIDERATIONS IN ADOLESCENT PLACEMENT
Transitional Age Youth
THE ASAM CRITERIA
Assessment-Based Treatment Matching and Clinical Appropriateness
Placement and Treatment Considerations by Assessment Dimension
Placement and Treatment Considerations by Levels of Care
Treatment Dose and Utilization Management
Validation of Placement Criteria
CONCLUSIONS
RESEARCH INTO CONFIDENTIALITY ISSUES
POLICIES ON CONFIDENTIALITY
DECIDING WHEN DISCLOSURE IS NECESSARY
SPECIAL CIRCUMSTANCES
BACKGROUND
THE POSITIONS TAKEN BY THE U.S. SUPREME COURT AND THE WHITE HOUSE
AMERICAN ACADEMY OF PEDIATRICS POLICY STATEMENTS
ETHICAL CONSIDERATIONS REGARDING COMPULSORY TESTING
CONCLUSION
CHAPTER 112 Adolescent Treatment and Relapse Prevention
INTRODUCTION
TREATMENT MODALITIES
FAMILY THERAPY
Multidimensional Family Therapy
Brief Strategic Family Therapy
Multisystemic Therapy
Functional Family Therapy
Behavioral Family Therapy
COGNITIVE–BEHAVIORAL THERAPY
TWELVE-STEP APPROACHES
Step 1
Step 2
Step 3
Step 4
Step 5
MOTIVATIONAL TREATMENT
Intervention Workbook
Adolescent Community Reinforcement Approach
Enthusiastic Sobriety Approach
Mindfulness-Based Approaches
Contingency Management
Neurofeedback
Pharmacotherapy
USING MULTIPLE THERAPIES
RELAPSE AND CONTINUED CARE
CASE STUDY
CHAPTER 113 Pharmacotherapies for Adolescents with Substance Use Disorders
INTRODUCTION
EMPIRICAL SUPPORT FOR PHARMACOTHERAPIES IN THE TREATMENT OF ADOLESCENT SUDS
Tobacco/Nicotine
Alcohol
Marijuana/Cannabis
Opioids
Cocaine
Over-the-Counter Medications and Other Drugs
Psychosocial Treatments
CLINICAL CONSIDERATIONS
Withdrawal Management
Overdose Management
Future Directions
BRIEF CLINICAL CASE
QUESTIONS
CHAPTER 114 Co-occurring Psychiatric Disorders in Adolescents
DEFINITIONAL ISSUES
METHODOLOGICAL QUESTIONS
INCIDENCE AND PREVALENCE
DIAGNOSIS AND MANAGEMENT
Depressive Disorders
Bipolar Disorder
Anxiety Disorders
Panic Attacks
Social Phobias, Generalized Anxiety disorder
Posttraumatic Stress Disorder
Substance-Induced Mental Disorders
Learning Disorders
Schizophrenia
Attention Deficit Hyperactivity Disorder
Conduct Disorder and Antisocial Personality Disorder
Borderline and Narcissistic Personality Disorders
Eating Disorders
CONCLUSIONS
SECTION 14 Ethical, Legal, and Liability Issues in Addiction Practice
CHAPTER 115 Ethical Issues in Addiction Practice
CORE ETHICAL PRINCIPLES
Autonomy
Beneficence
Nonmaleficence
Justice
Fidelity
DEALING WITH DENIAL
Talking to the Patient
Ordering Laboratory Tests
Older Patients
ESTABLISHING AN ETHICAL STANCE
Resources for Resolving Ethical Dilemmas
Summary: A Step-by-Step Model for Making Ethical Decisions
FUTURE DEVELOPMENTS
CHAPTER 116 Consent and Confidentiality Issues in Addiction Practice
INFORMED CONSENT
Information
Competency (Decisional Capacity)
Special Issues in Treating Older Adults
AGREEMENT TO TREATMENT
CONFIDENTIALITY PROTECTIONS
Basis of Confidentiality
Federal Laws Governing Confidentiality
State Laws Governing Confidentiality
Exceptions to Confidentiality Requirements
When Confidentiality Conflicts With Other Principles
SPECIAL ISSUES IN TREATING HEALTHCARE PROFESSIONALS
Engagement and Enrollment in Treatment
Treatment Records
Quarterly and Monthly Reports
Duty to Report
Protections for Patient Records
CHAPTER 117 Clinical, Ethical, and Legal Considerations in Prescribing Drugs With Potential for Nonmedical Use and Addiction
INTRODUCTION
FACTORS THAT CONTRIBUTE TO INAPPROPRIATE MEDICATION PRESCRIBING AND USE
UNIVERSAL PRECAUTIONS IN PRESCRIBING CONTROLLED MEDICATIONS
Conduct an Initial Patient Assessment and Risk Stratification, and Make a Diagnosis With an Appropriate Differential
Discuss the Proposed Treatment Plan with the Patient, and Obtain Informed Consent
Document Decisions in a Written Treatment Agreement or Informed Consent Form
Initiate an Appropriate Trial of Medication Therapy
Monitor the Patient’s Response to Pharmacotherapy
Based on the Patient’s Response, Decide Whether to Continue, Revise, or Terminate Medication Therapy
LEGAL REQUIREMENTS IN PRESCRIBING CONTROLLED MEDICATIONS
The Prescription Order
Maintaining Adequate Medical Records
CONCLUSIONS
Common Features of Recent Guidelines
Variations Across Recent Guidelines
NATIONAL GUIDELINES
STATE-SPECIFIC GUIDELINES, LAWS, AND REGULATIONS
CHALLENGES CONFRONTING THE DRAFTERS OF GUIDELINES
CATEGORIES:
CHAPTER 118 Medicinal Uses of Cannabis and Cannabinoids
FACTS ABOUT CANNABIS
The Epidemiology of Cannabis Use and Misuse
The Chemistry of Cannabis
CANNABIS OR CANNABINOIDS AS MEDICINE
Antiemetic Effects
Appetite Stimulant Effect
Analgesic Effect
Multiple Sclerosis
Spinal Cord Injuries
Gilles de la Tourette Syndrome
Epilepsy
Glaucoma
Parkinson Disease
Dystonia
Posttraumatic Stress Disorder
Other Potential Indications
THE PHYSICIAN’S ROLE IN PRESCRIBING CANNABIS OR CANNABINOIDS FOR MEDICINAL PURPOSES
CONCLUSIONS
CHAPTER 119 Practical Considerations in Drug Testing
THE EVOLUTION OF DRUG TESTING
THE SCIENCE OF DRUG TESTING
Assessment of Laboratory Test Results
Methods of Detecting Drugs
CHOICE OF TESTING MATRIX
Urine
Oral Fluid
Hair
LIMITATIONS OF DRUG TESTING
BIOMARKERS OF ALCOHOL CONSUMPTION
Ethyl Glucuronide and Ethyl Sulfate
Phosphatidyl Ethanol
ETHICAL ISSUES IN ALCOHOL AND DRUG TESTING
CHAPTER 120 Reducing Substance Use in Criminal Justice Populations
SCOPE OF THE PROBLEM
CONTINGENCY MANAGEMENT
Another Approach to Contingency Management
Physician Health Programs
PATHWAYS TO TREATMENT VIA CRIMINAL JUSTICE AGENCIES
Problem-Solving Courts
Portugal’s Commissions for the Dissuasion of Drug Addiction
CONCLUSIONS
CHAPTER 121 Preventing and Treating Substance Use Disorders in Military Personnel
HISTORICAL PERSPECTIVE ON SUDS IN THE MILITARY
Evolution of the Military Healthcare System
Drug Testing as a Deterrent
Alcohol Use and Alcohol Use Disorder
PREVALENCE OF SUDS AMONG MILITARY PERSONNEL
Sociodemographic Characteristics of Active Duty Personnel
Trends in Substance Use and SUDs
TREATMENT OF SUDS IN THE MILITARY MEDICAL SYSTEM
Delivering Treatment
Program Standards
Privacy and Confidentiality
Institute of Medicine Review
LEARNING FROM HISTORY
CONCLUSIONS
APPENDIX 1: ASAM Addiction Terminology
TERMINOLOGY
APPENDIX 2: Screening and Assessment Instruments
INTEGRATING SCREENING AND ASSESSMENT INTO CLINICAL PRACTICE
EXAMPLES OF VALIDATED SCREENING INSTRUMENTS FOR ADULTS
EXAMPLES OF VALIDATED SCREENING INSTRUMENTS FOR ADOLESCENTS
EXAMPLES OF VALIDATED ASSESSMENT INSTRUMENTS
CONCLUSIONS
APPENDIX 3: Crosswalks of The ASAM Criteria: Treatment Criteria for Substance-Related, Addictive and Co-Occurring Conditions
MULTIDIMENSIONAL ASSESSMENT
LEVELS OF CARE
CROSSWALK OF THE ADULT CRITERIA
CROSSWALK OF THE ADOLESCENT CRITERIA
APPENDIX 4: Summary of the DSM-5 Diagnostic Criteria
CHANGES IN THE DSM-5 CRITERIA FOR SUBSTANCE-RELATED DISORDERS
Other Changes in the DSM-5
APPENDIX 5: Summary of the ICD Coding Designations
CODES FOR MENTAL AND BEHAVIORAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE
DIAGNOSIS OF HARMFUL USE
DIAGNOSIS OF DEPENDENCE SYNDROME
APPENDIX 6: Federal Schedules of Controlled Drugs
CSA SCHEDULES
PRESCRIBING AUTHORITY
OTHER REQUIREMENTS
APPENDIX 7: Federation of State Medical Boards Model Policy on Office-Based Opioid Treatment (OBOT)
INTRODUCTION
SECTION I: PREAMBLE
SECTION II: GUIDELINES
SECTION III: DEFINITIONS
APPENDIX 8: Federation of State Medical Boards Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain
INTRODUCTION
SECTION I: PREAMBLE
SECTION II: GUIDELINES
SECTION III: DEFINITIONS
INDEX

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