Manual of Drug and Alcohol Abuse

1. Introduction and Definitions.- 1. Background.- 2. Organization and Structure of the Manual.- 3. Purpose and Aim.- 4. Methodology—How Was This Manual Produced?.- 5. Special Aspects of This Volume.- 6. Definitions and Terminology.- References.- I. Teaching Approaches.- 2. Guidelines for Teaching and Training.- 1. Introduction.- 2. Curriculum Design.- 2.1. Statement of the Problem: Sociomedical Crisis Today.- 2.2. Approaches to Curriculum Design.- 2.3. Problems in Curriculum Development.- 3. Curriculum Development.- 3.1. Instructional Tasks.- 3.2. Faculty and Students.- 3.3. Course Content.- 3.4. Timing and Location of Teaching Drug Dependence.- 3.5. Education Methods.- 3.6. Local Resources.- 4. Teaching Diagnostic Skills in Drug Dependence.- 4.1. Importance of Early Diagnosis.- 4.2. The Clinical Context.- 4.3. Elements of the Physician-Patient Relationship.- 4.4. Teaching the Interview Process.- 4.5. Teaching Assessment and Diagnostic Skills.- 5. Attitude Assessment and Change.- 5.1. Attitudinal Problems.- 5.2. Origins and Determinants of Attitudes.- 5.3. Attitudinal Measurement and Educational Goals.- 5.4. Teaching for Attitude Change.- 5.5. The Process of Attitude Change.- 6. Evaluation and Testing.- 6.1. Examination of the Student.- 6.2. Teacher Evaluation.- 7. Summary.- References.- Further Reading.- II. The Problem and its Assessment.- 3. Historical Background.- 1. Introduction.- 2. Drugs and Their Uses.- 2.1. Drug Discovery, Production, and Spread.- 2.2. Drug Uses.- 2.3. Routes of Administration.- 3. Evolution of Drug-Related Problems.- 3.1. Changing Concepts and Awareness.- 3.2. Transportation and Commerce.- 3.3. Technical Development.- 4. Social Controls over Drug Use and Abuse.- 4.1. Restrictions on Production and Import.- 4.2. Control of Therapeutic Drugs through Prescribing Laws.- 4.3. Taxation and Revenue.- 4.4. Prohibition.- 4.5. Other Sociocultural Approaches.- 4.6. Provision of Treatment Facilities.- 5. Drug-Abuse Problems Today.- References.- Further Reading.- 4. Epidemiological Assessment.- 1. Introduction.- 2. Sources of Data.- 2.1. Sales and Seizures.- 2.2. Registers.- 2.3. Surveys of Special Populations.- 2.4. Surveys of General Populations.- 2.5. Death Rates.- 2.6. Other Indicators.- 2.7. The Capture-Recapture Model.- 2.8. Special Aspects of Alcohol-Related Problems.- 2.9. Drug-Dependence Complications as Epidemiological Indicators.- 3. Extent of Drug Dependence Today.- 3.1. Opium and Heroin.- 3.2. Coca Leaf and Cocaine.- 3.3. Cannabis.- 3.4. Sedatives.- 3.5. Amphetamines.- 3.6. Alcohol.- 4. Demographic Variables.- 4.1. Gender.- 4.2. Age.- 4.3. Social and Other Variables.- 5. Current Global Trends in Drug Abuse and Dependence and Future Trends.- 5.1. Current Trends According to the Type of Drug Abuse and Dependence.- 5.2. Current Overall Global Trends.- 5.3. Populations at Risk.- 5.4. Future Trends in Drug Abuse and Dependence.- 5.5. Implications for Public Health.- 6. Morbidity and Mortality Related to Drug Abuse.- 7. Drug Dependence and Implications for Human Reproduction.- References.- Further Reading.- 5. Etiological Factors.- 1. Introduction.- 2. Host Factors.- 2.1. Genetic Factors.- 2.2. Neurotransmitters and Enzymes.- 2.3. Psychological Factors.- 3. Agent.- 3.1. Availability.- 3.2. Cost.- 3.3. Laws and Regulations.- 4. Environmental Factors.- 4.1. Culture.- 4.2. Family Influence.- 4.3. Peers.- 4.4. Secondary Reinforcers.- References.- Further Reading.- 6. Natural Course and Psychosocial Manifestations.- 1. Introduction.- 2. Course of Drug Dependence.- 2.1. Manifestations of the Course.- 2.2. Factors Affecting Course.- 3. Natural Course According to Type of Drug.- 3.1. Opioids.- 3.2. Alcohol.- 3.3. Cocaine.- 3.4. Tobacco.- 3.5. Cannabis.- 3.6. Polydrug Abuse.- 4. Psychosocial Consequences of Drug Dependence.- 4.1. Special Aspects.- 4.2. The Family.- 4.3. Types of Families in Drug Dependence.- 4.4. Family Health Problems.- 5. Recovery.- 5.1. Chronology of Recovery.- 5.2. Psychological Concomitants of Recovery.- 5.3. Social Concomitants of Recovery.- 5.4. Clinical and Demographic Considerations.- 5.5. Recovery According to Different Drugs of Abuse.- References.- III. Pharmacological Factors.- 7. Pharmacology of Dependence-Producing Drugs.- 1. Introduction.- 2. Metabolism and the Drugs of Abuse.- 2.1. Absorption.- 2.2. Drug Distribution.- 2.3. Termination of Drug Actions.- 2.4. Quantitative Characterization of Drug Action.- 2.5. Special Pharmacological Issues Related to Drugs of Dependence.- 3. Opioids.- 3.1. Sources of Opioids and Their Antagonists.- 3.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 3.3. Effects.- 3.4. Tolerance, Dependence, Abstinence Syndrome.- 4. Alcohol (Ethanol, Ethyl Alcohol).- 4.1. Forms of Alcohol.- 4.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 4.3. Effects.- 4.4. Tolerance, Dependence, Abstinence Syndrome.- 5. Sedatives (Including Benzodiazepines).- 5.1. Forms of the Drugs.- 5.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 5.3. Effects.- 5.4. Tolerance, Dependence, Abstinence Syndrome.- 6. Amphetamines.- 6.1. Administration, Absorption, Distribution, Metabolism, Excretion.- 6.2. Effects.- 6.3. Tolerance, Dependence, Abstinence Syndrome.- 7. Cocaine.- 7.1. Forms of the Drug.- 7.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 7.3. Effects.- 7.4. Tolerance, Dependence, Abstinence Syndrome.- 8. Cannabis.- 8.1. Forms of the Drug.- 8.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 8.3. Effects.- 9. Tobacco/Nicotine.- 9.1. Forms of the Drug.- 9.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 9.3. Effects.- 9.4. Tolerance, Dependence, Abstinence Syndrome.- 10. Caffeine.- 10.1. Forms of the Drug.- 10.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 10.3. Effects.- 10.4. Tolerance, Dependence, Abstinence Syndrome.- 11. Volatile Solvents-Inhalants.- 11.1. Aromatic Hydrocarbons.- 11.2. Aliphatic Hydrocarbons.- 11.3. Halogenated Solvents and Propellants.- 11.4. Trichlorinated Solvents.- 11.5. Inhalational Anesthetic Drugs.- 11.6. Aliphatic Nitrites.- 12. Phencyclidine.- 12.1. Administration, Absorption, Distribution, Metabolism, Excretion.- 12.2. Effects.- 13. D-Lysergic Acid and Related Compounds.- 13.1. Indolylalkylamines.- 13.2. Phenylalkylamine Derivatives.- 14. Atropinelike Substances.- 15. Betel-Areca.- 16. Khat (Chat, Qat).- 17. Combined Drug Effects.- References.- Further Reading.- IV. Diagnosis and Management.- 8. Clinical Diagnosis and Assessment.- 1. Introduction.- 2. Background Factors.- 2.1. Interaction between the Physician, Patient, and Community.- 2.2. Reason for Consultation.- 3. History Taking.- 3.1. Content and Process of History Taking.- 3.2. Chief Complaint.- 3.3. Present Illness, Review of Systems, Family History, and Social History.- 3.4. Drug Use History.- 4. Physical Examination.- 5. Laboratory Testing and Screening.- 6. Self-Rating Scales.- 7. Collateral Informants and Family Assessment.- 8. Communicating the Diagnosis.- References.- Further Reading.- 9. Detoxification and Management of Medical Emergencies.- 1. Introduction.- 2. Intoxication.- 2.1. Acute Pathological Intoxication.- 2.2. Acute Anxiety, Panic Attack.- 2.3. Toxic Psychosis.- 2.4. Drug-Precipitated Psychosis.- 2.5. Special Problems Associated with Intoxication.- 2.6. General Treatment Measures.- 2.7. Specific Treatment Measures.- 3. Overdose.- 3.1. General Measures.- 3.2. Specific Measures.- 4. Withdrawal.- 4.1. Principles of Withdrawal Therapy.- 4.2. General Measures.- 4.3. Specific Measures.- 5. Other Acute Conditions.- 5.1. Wernicke-Korsakoff Encephalopathy.- 5.2. Management of Medical or Surgical Problems.- References.- Further Reading.- 10. Medical Complications.- 1. Introduction.- 2. Nonspecific Complications.- 2.1. Malnutrition.- 2.2. Infectious Disease.- 2.3. Trauma.- 2.4. Psychiatric Disorders.- 2.5. Psychosomatic Disorders.- 3. Mode of Administration.- 3.1. Ingestion.- 3.2. Chewing.- 3.3. Nasal Insufflation.- 3.4. Smoking.- 3.5. Parenteral Injection.- 4. Drug-Specific Complications.- 4.1. Opioids.- 4.2. Alcohol.- 4.3. Sedative-Hypnotics, Anxiolytics.- 4.4. Amphetamines.- 4.5. Cocaine.- 4.6. Hallucinogens.- 4.7. Phencyclidine.- 4.8. Cannabis.- 4.9. Nicotine/Tobacco.- 4.10. Caffeine.- 4.11. Volatile Inhalants.- 4.12. Designer Drugs.- References.- Further Reading.- 11. Psychosocial Management.- 1. Introduction.- 2. Principles of Psychosocial Treatment.- 2.1. Individual Assessment Prior to Treatment.- 2.2. Building a Therapeutic Alliance.- 2.3. Early Abstinence.- 2.4. Facilitating Recovery.- 2.5. Helpful Approaches for the Clinician.- 2.6. Phasing Therapeutic Priorities and Tasks.- 3. Individual Treatment Approaches.- 3.1. Physician-Patient Relationship.- 3.2. Behavior Therapy.- 3.3. Contingency Contracting (Contingency Management, Therapeutic Contracting).- 4. Family Treatments.- 4.1. Principles of Family Treatment.- 4.2. Treating Particular Family Types.- 5. Group Treatment.- 5.1. Psychodrama, Social Skills Learning.- 5.2. Group Psychotherapy.- 6. Inpatient and Residential Treatment.- 6.1. Indications for Inpatient or Residential Care.- 6.2. Hospital Units for Drug Dependence.- 6.3. Therapeutic Communities.- 6.4. Partial Care Residences.- 6.5. Emergency Service Centers (Detoxification Stations).- 7. Day, Evening, and Weekend Programs.- 8. Outpatient Follow-up Treatment.- 9. Religious Programs.- 10. Self-Help Groups.- 11. Multimodality Approach.- 12. Making an Effective Referral.- References.- Further Reading.- 12. Pharmacotherapy.- 1. Introduction.- 2. Principles in the Pharmacotherapy of Drug Dependence.- 3. Opioid Maintenance (Substitution Therapy).- 3.1. Methadone and Opium Maintenance.- 3.2. Withdrawing the Patient from Maintenance.- 3.3. Weak Opioid Drugs.- 4. Naltrexone Therapy.- 5. Disulfiram Therapy.- 6. Nicotine Maintenance (Substitution Therapy).- 7. Tricyclic Antidepressant Therapy.- 8. Electroacupuncture.- 9. Aversion Therapies.- 9.1. Electrical Aversion.- 9.2. Chemical Aversion.- References.- V. Public Health Approaches.- 13. Public Health Planning.- 1. Introduction.- 2. Drug Dependence from a Public Health Perspective.- 2.1. Nature and Extent of the Problem.- 2.2. Assessing Etiological Factors.- 2.3. Consequences for the Community.- 3. Public Health Approaches.- 3.1. Intervention: Policy.- 3.2. Intervention: Strategy.- 4. Program Planning, Development, and Management.- 4.1. Characteristics of Treatment Programs.- 4.2. Goal Setting and Treatment Objectives.- 4.3. Operation of the Program.- 4.4. Program Evaluation.- 4.5. Influence of Treatment on Clinical Outcome.- 4.6. Methodological Issues in Studying Outcome.- 4.7. Cost Benefit.- 4.8. Cost Effectiveness.- References.- Further Reading.- 14. Prevention.- 1. Introduction.- 2. Public Health Approaches.- 3. Role of Public Policy.- 3.1. Public Policy toward Drugs.- 3.2. Standard Control Policies.- 4. Classification of Prevention.- 5. Primary Prevention.- 5.1. Populations at Risk.- 5.2. Education.- 5.3. Strategies Utilizing the Agent.- 5.4. Strategies Utilizing Host Factors.- 5.5. Strategies Utilizing Environmental Factors.- 6. Secondary Prevention.- 6.1. Screening for Drug Dependence.- 6.2. Case Finding in the Clinical Setting.- 6.3. Prescribing to Prevent Dependence.- 6.4. Early Case Finding in Nonclinical Settings.- 7. Tertiary Prevention.- 7.1. Prevention of Medical Complications.- 7.2. Patient Registration and Community Surveillance.- References.