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Preface | |
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Acknowledgments | |
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Clinical Pharmacology and Clinical Epidemiology of Psychoactive Substances | |
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Definitions and General Concepts of Pharmacology | |
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Pharmacology of Individual Drugs | |
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Central Nervous System Stimulants | |
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Cocaine | |
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Amphetamines | |
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Caffeine | |
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Nicotine | |
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Central Nervous System Depressants | |
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Alcohol | |
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Barbiturates | |
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Benzodiazepines | |
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Cannabinoids | |
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Opioids | |
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Heroin | |
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Codeine | |
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Methadone | |
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Hallucinogens | |
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Mescaline | |
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LSD | |
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Psilocybin and Psilocin | |
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PCP | |
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Solvent and Aerosol Inhalants | |
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Steroids | |
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Clinical Epidemiology of Psychoactive Substances | |
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General Trends | |
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Trends of Specific Substance Use | |
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Alcohol | |
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Other CNS Depressants | |
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CNS Stimulants | |
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Caffeine | |
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Nicotine | |
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Marijuana | |
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Opioids | |
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Hallucinogens | |
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Inhalants | |
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Steroids | |
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References | |
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Etiology of Psychoactive Substance Use Disorders | |
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Overview | |
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Theories of Etiology | |
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Genetic Research | |
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Psychological Theories | |
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Psychodynamic Theories | |
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Behavioral/Cognitive-Behavioral Theories | |
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Family Models | |
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References | |
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Initiation, Progression, and Maintenance of Psychoactive Substance Use Disorders | |
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Stage Models of Adolescent Substance Use | |
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Risk Factors | |
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Risk Factors for Use versus Abuse | |
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Adult Model of Substance Use | |
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References | |
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Course/Natural History of Psychoactive Substance Use Disorders | |
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The Disease Model | |
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Classic Model of Progression of Alcoholism | |
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Longitudinal Study of Alcohol Abuse | |
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Models of Progression of Substance Use | |
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Stage Model of Progression | |
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Spontaneous Remission of Substance Abuse | |
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Stages of Change Model | |
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References | |
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Prevention, Early Intervention, and Harm Reduction | |
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General Perspective | |
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Types of Prevention | |
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Targets of Prevention Efforts | |
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Types of Interventions | |
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Supply Reduction/Legal Interventions | |
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Risk and Protective Factors | |
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Risk Factors | |
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Broad Social and Cultural Factors Associated with Elevated Risk of Substance Abuse | |
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Individual and Interpersonal Environmental Factors Associated with Elevated Risk of Substance Abuse | |
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Protective Factors Mitigating Risk of Substance Abuse | |
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Skills Training | |
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Community-Based Prevention | |
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School-Based Programs | |
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Parenting/Family Interventions | |
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Related Risks/Harm Reduction | |
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HIV and Substance Abuse | |
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Pregnant Adolescents/Adolescent Mothers | |
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Reducing Alcohol Consumption | |
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References | |
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Screening and Assessment of Psychoactive Substance Use | |
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Overview of the Assessment Process | |
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Stage Models of Assessment | |
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Illustrative Stage Models of Assessment of Psychoactive Substance Use Disorders | |
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Validity of Self-Report Data | |
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Factors Associated with Accurate Self-Report of Psychoactive Substance Use | |
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Psychometric Properties of Assessment Instruments | |
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Alcohol Screening Instruments | |
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Michigan Alcohol Screening Test (MAST) | |
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CAGE Questionnaire | |
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TWEAK | |
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Alcohol Use Disorders Identification Test (AUDIT) | |
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MacAndrew Alcoholism Scale (MAC) | |
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Adolescent-Specific Scales | |
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Adolescent Alcohol Involvement Scale (AAIS) | |
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MacAndrew Alcoholism Scale for Adolescents (MAC-A) | |
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Rutgers Alcohol Problem Index (RAPI) | |
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Drug Screening Instruments | |
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Drug Abuse Screening Test (DAST) | |
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Drug Use Screening Inventory (DUSI) | |
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Biological Screening Measures | |
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Alcohol-Specific Biological Screening Measures | |
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Measurement of Recent Use | |
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Measurement of Long-Term Alcohol Abuse | |
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Laboratory Assessment of Drugs Other Than Alcohol | |
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Methods of Measurement of Recent Use | |
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Assessment of Chronic Drug Abuse | |
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Diagnostic Instruments | |
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The Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) | |
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Composite International Diagnostic Interview: Authorized Core Version 1.0 (CIDI-Core) | |
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Structured Clinical Interview for DSM III-R (SCID) | |
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Addiction Severity Index (ASI) | |
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Fagerstrom Tolerance Questionnaire (FTQ) | |
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Clinical Institute Withdrawal Assessment-Revised (CIWA-AR) | |
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Knowledge of Symptoms of Withdrawal and Intoxication | |
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Measures of Consumption of Alcohol and Other Substances | |
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Lifetime Drinking History (LDH) | |
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Quantity-Frequency Methods (QF) | |
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Timeline Follow Back (TLFB) | |
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Self-Monitoring | |
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Knowledge of High-Risk Groups | |
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Knowledge of Diagnostic Criteria | |
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Areas to Assess for Treatment Planning Purposes | |
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Neuropsychological Screening | |
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Expectancy Measures | |
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Assessment of Motivation for Change | |
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Assessment of High-Risk Situations | |
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Assessment of Family Functioning | |
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Awareness of Common Family Dynamics | |
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Illustrative Example and Discussion of a Complete Psychosocial/Substance Use Assessment Form | |
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Presentation of the Assessment Form | |
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Examples of Specific Questions to Ask and Rationales for Inclusion of Items on the Assessment Form | |
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References | |
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Diagnosis and Comorbidity | |
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Definition and Prevalence | |
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Percentage of Alcohol Abusers Presenting with Comorbid Psychiatric Disorders | |
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Percentage of Drug Abusers Presenting with Comorbid Psychiatric Disorders | |
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Percentage of Psychiatric Cases Presenting with Substance Abuse or Dependence | |
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Diagnostic Issues of the Dually Impaired | |
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Complicating Factors | |
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Improvement of Diagnostic Validity | |
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Illustrative Clinical Cases | |
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Treatment of the Dually Diagnosed | |
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Traditional Approaches | |
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Parallel Treatment Systems | |
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Integrated Treatment Systems | |
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References | |
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Treatment I: Models and Approaches | |
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Treatment Settings and Services | |
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Placement Criteria | |
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Major Theoretical Treatment Approaches | |
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Current Psychoanalytic/Psychodynamic Approaches | |
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Neurotic Conflict | |
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Ego- and Self-Deficits | |
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Deficits in Affective Functioning and Object Relations | |
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Psychosomatic Disorders | |
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Elements Common to Psychoanalytic Theories of Substance Abuse | |
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Strengths and Weaknesses of Psychoanalytic Theories of Substance Abuse | |
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Family Therapies | |
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Family Disease Model | |
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Behavioral Model | |
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Family Systems Model | |
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Strengths and Weaknesses of Family Theories of Substance Abuse | |
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Behavioral/Cognitive Behavioral Approaches | |
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Classical Conditioning | |
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Operant Conditioning | |
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Social Learning Theory | |
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Strengths and Weaknesses of Behavioral Approaches to the Treatment of Substance Abuse | |
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Client-Centered/Motivational Interviewing | |
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Biopsychosocial Model | |
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12-Step Programs | |
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Therapeutic Community | |
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Additional Psychological Therapies | |
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Social Skills Training | |
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Contingency Management | |
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Aversion Therapies | |
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Community Reinforcement Approach (CRA) | |
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Relapse Prevention | |
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Common Elements of Relapse Prevention Programs | |
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Cue Exposure | |
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Behavioral Self-Control | |
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Stress Management | |
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Network Therapy | |
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Role of Pharmacotherapy | |
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Cocaine | |
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Alcohol | |
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Opioids | |
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Nicotine | |
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Treatment Effectiveness/Outcome Studies | |
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Therapist Factors | |
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Patient Factors | |
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Program Services | |
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Duration of Treatment | |
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Theoretical Orientation | |
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Alternative Treatments | |
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Acupuncture | |
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Transcendental Meditation (TM) | |
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Concluding Remarks on Acupuncture and TM | |
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References | |
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Treatment II: Planning, Implementing, and Managing Treatment and the Course of Recovery | |
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Phases of Recovery | |
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Relapse Parameters | |
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Treatment Goals | |
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Traditional Abstinence Goals | |
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Controlled Use of Alcohol | |
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Detoxification | |
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Engagement of Patients in Treatment | |
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Client-Treatment Matching | |
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Project Match | |
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Treatment of Family Members of Substance Abusers | |
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Linkage of Services | |
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Treatment of Criminal Offenders | |
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Driving-Related Offenders | |
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Treatment of the Incarcerated | |
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Self-Help Groups | |
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Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) | |
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AL-ANON and ALATEEN/NAR-ANON and NARATEEN | |
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Women for Sobriety | |
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Rational Recovery | |
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References | |
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Issues in Specific Populations | |
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Impaired Physicians | |
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Definition and Risk Factors | |
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Treatment of Physicians | |
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Ethnic Minorities | |
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Prevalence and Etiological Factors | |
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Cultural Influences on Substance Abuse | |
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Treatment of Ethnic Minorities | |
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Barriers to Treatment for Ethnic Minorities | |
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Women | |
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Prevalence of Substance Abuse | |
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Barriers to Treatment for Women | |
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Treatment Needs of Women | |
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HIV/AIDS | |
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Prevention with Adolescents | |
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Barriers to Treatment for Adolescents | |
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Barriers to Treatment and Treatment Needs of Those with HIV/AIDS | |
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The Elderly Population | |
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Diagnostic Issues | |
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Treatment of the Elderly Population | |
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The Homeless Population | |
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Prevalence of Substance Abuse | |
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Underutilization of Services | |
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References | |
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Legal and Ethical Issues | |
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Confidentiality | |
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Rationale for Confidentiality | |
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Federal Guidelines for Valid Consent to Disclose Information | |
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Disclosure without Patient Consent | |
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Confidentiality and HIV Status | |
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Confidentiality and Illegal Behavior | |
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Confidentiality and Minors | |
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Responsibility to Diagnose and Treat Substance Use Disorders | |
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Coerced Treatment | |
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Driving While Intoxicated (DWI) Programs | |
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Referral for Treatment by Social Service Agencies | |
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Treatment of Pregnant Mothers | |
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Americans with Disabilities Act (ADA) | |
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Description of the ADA | |
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Application of the ADA to Substance Abusers | |
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References | |
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Epilogue | |
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Index | |