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| Preface | |
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| Alcohol | |
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| Once Upon a Time... | |
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| Fermentation and Discovery of Distillation | |
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| Alcohol Use in America | |
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| Why Bother? | |
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| Theories to Explain Alcohol Use | |
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| Myths | |
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| Alcohol Problems: The Fly in the Ointment | |
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| Problems as Sin or Moral Failing | |
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| Problems as a Legal Issue | |
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| America's Response to Alcohol Problems | |
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| Drunkenness versus Alcoholism | |
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| History of Alcohol Treatment Efforts | |
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| Public Policy and Alcohol | |
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| Advertising | |
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| Changing Norms | |
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| Other Drug Use | |
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| Tobacco | |
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| Marijuana | |
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| References and Suggested Reading | |
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| Alcohol and Its Costs | |
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| Who Drinks What, When, and Where | |
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| Drinking Patterns | |
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| Alcohol Problems | |
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| Abuse and Dependence | |
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| Economic Costs versus Economic Benefits | |
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| Personal Costs | |
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| Health Care and Alcohol | |
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| References and Suggested Reading | |
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| Alcohol and the Body | |
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| Ingestion and Absorption | |
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| Blood Alcohol Concentration | |
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| Breakdown and Removal | |
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| Alcohol's Acute Effects on the Body | |
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| Digestive System | |
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| Circulatory System | |
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| Kidneys | |
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| Liver | |
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| Central Nervous System | |
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| Acute Overdose and Toxicity | |
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| Differences in Women | |
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| Tolerance | |
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| Alcohol as an Anesthetic | |
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| Other Types of Alcohol | |
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| The Influence of Expectations | |
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| Advice for the Moderate Drinker | |
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| Contraindications to Moderate Use | |
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| Alcohol-Drug Interactions | |
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| The Basis of Alcohol-Drug Interactions | |
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| Problems Associated with Drinking and Intoxication | |
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| Alcohol Use and Exercise | |
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| In Conclusion | |
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| References and Suggested Reading | |
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| Alcohol Dependence | |
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| Definitions | |
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| Early Definitions | |
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| Toward Uniformity in Terminology | |
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| A Disease? | |
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| Implications of Disease Classification | |
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| Criticisms of the Disease Concept | |
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| Natural History | |
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| Jellinek's Phases of Alcoholism | |
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| Types of Alcoholism: Jellinek's Species | |
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| Current Thinking | |
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| Guides for Diagnosis | |
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| NCA Criteria | |
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| Diagnostic Criteria of the American Psychiatric Association | |
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| Natural History of Alcoholism: Jellinek Revisited | |
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| References and Suggested Reading | |
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| Etiology of Alcohol Dependence | |
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| Public Health Model | |
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| The Agent | |
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| The Host-Genetic Factors | |
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| Nature and Nurture | |
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| Twin and Adoption Studies | |
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| Studies of Nonalcoholic Blood Relatives | |
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| Genetic Markers | |
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| Familial versus Nonfamilial Alcohol Dependence: So What? | |
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| The Host-Personality and Psychological Makeup | |
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| Psychological Needs | |
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| Early Psychological Approaches | |
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| Personality Theories Applied to Alcohol Dependence | |
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| Current Thinking | |
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| The Environment-Sociological Factors | |
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| Cultural Orientation | |
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| Drinking Styles and Alcohol Problems | |
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| Influence of Cultural Subgroups | |
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| Legal Sanctions and Approaches | |
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| Cross-Cultural Comparisons | |
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| Cultural Influences on Recovery | |
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| Views in the Twenty-First Century | |
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| References and Suggested Reading | |
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| Medical Complications | |
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| Visible Signs and Symptoms of Chronic Heavy Drinking | |
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| Gastrointestinal System | |
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| Irritation, Bleeding, and Malabsorption | |
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| Pancreatitis | |
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| Gallbladder Disease | |
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| Liver Disease | |
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| Gastrointestinal Cancers | |
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| Hematological System | |
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| Red Blood Cells | |
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| White Blood Cells | |
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| Platelets | |
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| Clotting Factors and DIC | |
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| Immune System | |
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| Cardiovascular System | |
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| Genitourinary System | |
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| Urinary Tract | |
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| Reproductive System and Pregnancy | |
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| Respiratory System | |
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| Endocrine System | |
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| Cancer | |
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| Skin | |
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| Skeletal System | |
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| Nervous System | |
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| Dependence, Tolerance, Craving, and Withdrawal | |
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| Alcohol Idiosyncratic Intoxication (Pathological Intoxication) | |
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| Organic Brain Disease | |
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| Nerve and Muscle Tissue Damage | |
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| Subdural Hematomas | |
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| Miscellaneous CNS Disturbances | |
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| Neuropsychological Impairment | |
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| Miscellaneous Effects | |
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| Sleep and Sleep Disturbances | |
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| Sleep Stages | |
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| Sleep Disturbances | |
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| Insomnia | |
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| Alcohol's Effects on Sleep | |
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| Blackouts | |
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| Withdrawal Syndromes | |
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| Hyperarousal | |
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| Alcoholic Hallucinosis | |
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| Convulsive Seizures | |
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| Delirium Tremens | |
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| Late Withdrawal Phenomenon | |
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| Some Cautions | |
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| References and Suggested Reading | |
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| The Behavior of Dependence | |
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| A Behavioral Composite | |
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| How, If Not Why? | |
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| Deteriorating Functioning | |
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| Family and Friends | |
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| Work | |
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| Other Drugs of Abuse | |
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| A Final Thought | |
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| References and Suggested Reading | |
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| Effects of Alcohol Problems on the Family | |
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| The "Family Illness" | |
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| The Family's Response | |
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| The Family System | |
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| Enabling | |
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| Co-dependency | |
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| Current Thinking | |
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| Children in the Family | |
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| Children in the Home | |
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| Children's Coping Styles | |
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| Adult Children | |
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| Resiliency | |
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| Genetic Vulnerability | |
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| Alcohol Dependence in Other Family Members | |
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| Other Substance Use and Its Impact on the Family | |
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| References and Suggested Reading | |
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| Evaluation and Treatment Overview | |
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| Theoretical Perspectives | |
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| Problems of Use | |
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| Chronic Disease Framework | |
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| Challenges of Problems Associated with Use | |
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| Screening and Evaluation | |
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| Laboratory Tests | |
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| Screening Instruments | |
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| Initial Follow-Up Questions | |
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| Identifying Situations Requiring Medical Attention | |
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| Substance Use History | |
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| Clinical Style | |
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| Motivation | |
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| History Taking | |
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| What's Next? | |
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| Making a Referral | |
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| Evaluation in a Substance Abuse Treatment Setting | |
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| Treatment Planning and Treatment Settings | |
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| Treatment of Alcohol Problems and Alcohol Abuse | |
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| Alcohol Incidents | |
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| Alcohol Abuse | |
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| Treatment of Alcohol Dependence | |
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| Obstacles to Treatment | |
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| Factors in Successful Treatment | |
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| Recovery Process | |
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| Common Treatment Issues | |
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| References and Suggested Reading | |
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| Treatment Techniques and Approaches | |
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| Individual Counseling | |
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| Observation | |
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| Feedback | |
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| Education | |
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| Self-Disclosure | |
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| Client Responsibility | |
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| Possible Mis-steps | |
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| Problem Identification and Problem Solving | |
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| The Therapeutic Relationship | |
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| Case Management and Administrative Tasks | |
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| Group Work | |
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| Group as Therapy | |
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| Types of Groups | |
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| Group Functions | |
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| Groups as a Diversion | |
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| Working with Families | |
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| Family Members Troubled by Another's Alcohol Use | |
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| Family Interventions | |
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| Family Treatment in Conjunction with Alcohol Treatment | |
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| Suggestions for Working with Families during Treatment | |
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| Family Issues | |
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| Couples Therapy | |
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| Self-Help for Families | |
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| Self-Help | |
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| Alcoholics Anonymous (AA) | |
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| Other Self-Help Groups | |
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| Which Self-Help Approach? | |
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| Other Approaches | |
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| Spiritual Counseling | |
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| Meditation | |
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| Activities Therapy | |
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| Behavioral Approaches | |
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| Pharmacotherapy | |
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| Disulfiram (Antabuse) | |
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| Anticraving Agents | |
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| Treatment Matching | |
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| References and Suggested Reading | |
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| Special Populations | |
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| Adolescents | |
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| Developmental Issues | |
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| Alcohol and Other Drug Use | |
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| Associated Problems | |
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| Working with Adolescents | |
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| A Framework for Addressing Adolescent Substance Use/Problems | |
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| Further Assessment and Treatment | |
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| College Students | |
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| Patterns of Alcohol and Other Drug Use | |
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| Problems Associated with Substance Use | |
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| Perceived Benefits Associated with Drinking | |
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| Students at Risk | |
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| Natural History of Collegians' Alcohol Use | |
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| Impetus to Institutional Action | |
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| Impediments to Campus Programs | |
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| Campus Initiatives | |
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| Intervention and Treatment | |
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| Antismoking Efforts | |
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| Closing Thoughts | |
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| The Elderly | |
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| Stresses of Aging | |
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| Patterns of Alcohol and Other Drug Use | |
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| Alcohol Use and Health Status | |
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| Alcohol Problems | |
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| Prevention | |
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| Working with Elderly People | |
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| Women | |
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| Gender Differences | |
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| Differences among Women | |
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| Natural History of Alcohol and Other Drug Problems in Women | |
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| Assessment | |
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| Treatment Approaches | |
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| Treatment Themes | |
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| Treatment Issues for Pregnant Women | |
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| The Workplace | |
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| Some Basic Statistics | |
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| High-Risk Factors | |
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| The Workplace Response | |
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| Workplace Interventions | |
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| Implications for Treatment | |
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| Other Special Populations | |
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| References and Suggested Reading | |
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| Other Psychiatric Considerations | |
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| Suicide Evaluation and Prevention | |
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| Statistics and High-Risk Factors | |
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| How to Ask about Suicide | |
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| Responding to Suicidal Patients | |
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| Mental Status Examination | |
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| Major Categories of Co-occurring Psychiatric Illness | |
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| Mood Disorders | |
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| Disorders Involving Psychosis | |
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| Anxiety Disorders | |
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| Personality Disorders | |
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| Attention-Deficit/Hyperactivity Disorder | |
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| Psychiatric Disorders Due to a General Medical Condition | |
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| Other Drug Dependence and Alcohol Abuse/Dependence | |
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| Other Addictive Behaviors | |
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| Clinical Considerations | |
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| Homelessness, Alcohol Use, and Chronic Mental Illness | |
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| Psychotropic Medications | |
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| Antipsychotic Medications | |
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| Antidepressant Medications | |
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| Mood Stabilizers | |
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| Anti-Anxiety Agents | |
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| References and Suggested Reading | |
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| Drugs of Abuse Other Than Alcohol | |
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| Drug Use Patterns | |
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| Age | |
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| Gender | |
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| Education | |
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| Employment | |
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| Geographic Region | |
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| Social Costs | |
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| Public Perceptions and Public Policies | |
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| Legal Status | |
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| Early Control Efforts | |
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| Sources of Illicit Drugs | |
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| Reducing Drug Diversion | |
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| Basic Pharmacological Concepts | |
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| How to Think about Drug Use | |
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| Route of Administration | |
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| Site of Action | |
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| Solubility in Fat and/or Water | |
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| Metabolism | |
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| Withdrawal | |
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| Abuse Potential | |
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| Problems | |
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| Toxicity and Overdose | |
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| Classification Schemas for Substances of Abuse | |
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| Licit versus Illicit | |
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| DEA Schedule | |
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| Pharmacological Effects | |
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| Major Classes of Commonly Abused Drugs | |
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| Nicotine | |
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| Opiates | |
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| Sedative-Hypnotics (Central Nervous System Depressants) | |
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| Stimulants | |
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| Hallucinogens and Dissociatives | |
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| Cannabinoids | |
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| Inhalants | |
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| Anabolic Androgenic Steroids | |
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| Caffeine | |
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| Other Psychoactive Drugs Used Worldwide | |
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| Clinical Issues | |
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| Assessment | |
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| Treatment Goals | |
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| Harm Reduction | |
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| Pharmacological Treatment | |
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| Pregnancy and the Use of Drugs Other Than Alcohol | |
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| International Comparisons | |
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| References and Suggested Reading | |
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| Odds 'n' Ends | |
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| Beyond Counseling | |
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| Educational Activities | |
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| Training Others | |
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| Prevention | |
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| The Real World | |
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| Being a Professional Colleague | |
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| Selecting a Professional Position | |
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| Being a Professional | |
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| Certification and Licensure | |
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| Ethics | |
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| Basic Principles | |
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| Confidentiality | |
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| Setting Boundaries | |
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| Counselors with "Two Hats" | |
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| Clinician Impairment and Relapse | |
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| References and Suggested Reading | |
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| Organizations and Resources in the Substance Abuse Field | |
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| The Interaction Effects of Alcohol with Other Drugs | |
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| Diagnostic Criteria: Substance Use Disorders | |
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| Index | |