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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 | |