Here at last is a comprehensive book on the often-ignored but vitally important subject of care for the chemically dependent adolescent. Written by professionals who have worked extensively with chemically dependent youth, Practical Approaches in Treating Adolescent Chemical Dependency features: a comprehensive overview of the dynamics of adolescence and the destructive impact that chemicals have upon kids a description of adolescents who are at risk for chemical dependency guidelines for making accurate assessments of chemically dependent adoles.
Score: 5. But is being addicted to something necessarily bad? These attitudes are explicit both in contemporary medical literature and in popular, self-help texts. We categorise addiction as unnatural, diseased and self-destructive. We demonise pleasure and desire, and view the addict as physically and morally damaged.
Helen Keane's thought-provoking text examines these assumptions in a new light. In asserting that the 'wrongness' of addiction is not fixed or indeed obvious, she presents a refreshing challenge to more conventional accounts of addiction. She also investigates the notion that people can be addicted to eating, love and sex, just as they are to drugs and alcohol. What's Wrong with Addiction? It exposes strains in our society's oppositions between health and disease, between the natural and the artificial, between order and disorder, and between self and other.
The authors cover the scientific and clinical aspects of chemical dependency in a balanced way with case vignettes to illustrate clinical issues. The book is suitable for a number of student needs. Students preparing for the Certified Alcoholism and Substance Abuse Counselor CASAC examination will find topics discussed that are drawn from the certification examination requirements.
Page 56 Chapter Summary Page 63 Scope of the Problem Page 65 Physical Dependence, Tolerance, and "Craving" Page 66 Complications of Chronic Alcohol Use Page 67 The Alcohol Withdrawal Syndrome Page 77 Chapter Summary Page 81 Pharmacology of the Barbiturates Page 85 The Barbiturate-Like Drugs Page 86 Chapter Summary Page 89 The Pharmacology of the Benzodiazepines Page 93 Neuroadaptation to, Misuse of, and Addiction to the Benzodiazepines Page 98 Rohypnol Page Chapter Summary Page I.
Page II. CNS Stimulant Misuse Page A Brief History of Cocaine Page Pharmacology of Cocaine Page Methods of Cocaine Misuse Page Chapter Marijuana Use and Misuse Page Anecdotal Claims of Efficacy Page A Technical Point Page The Pharmacology of Marijuana Page Methods of Marijuana Use Page Subjective Effects of Marijuana Use Page Adverse Effects of Marijuana Misuse Page Chapter Opioid Use and Misuse The Medical Applications of Narcotic Analgesics Opiates as Drugs of Misuse Page Chapter Hallucinogen Misuse Page A Short History of Hallucinogens Page Pharmacology of the Hallucinogens Page Phencyclidine PCP Page Salvia Divinorum Page The Pharmacology of the Inhalants Page Scope of the Problem of Inhalant Misuse Page Subjective Effects of Inhalants Page Complications Induced by Inhalant Misuse Page Anesthetic Misuse Page Scope of the Problem of Steroid Misuse Page Pharmacology of Anabolic-Androgenic Steroids Page Sources and Methods of Steroid Misuse Page Are Anabolic Steroids Addictive?
Page Are Misused Steroids Effective? Page Scope of the Problem of Tobacco Use Page The Pharmacology of Cigarette Smoking Page The Effects of Nicotine on the Body Page Secondhand Smoke Page Smoking Cessation Page OTC Overdoses Page Chapter Chemicals and the Neonate Page Scope of the Problem Page Alcohol Page Benzodiazepine Use during Pregnancy Page Cigarette Smoking during Pregnancy Page Cocaine Use during Pregnancy Page Inhalant Misuse during Pregnancy Page Marijuana Use during Pregnancy Page Narcotic Analgesic Use during Pregnancy Page Substance Use Disorders in Women Page Alcohol Use Disorders in Women Page Benzodiazepine Misuse by Women Page Hallucinogen Misuse by Women Page Narcotics Misuse by Women Page Nicotine Misuse by Women Page Substance Use Disorders and the Homeless Page Substance Use Disorders in the Military Page Substance Misuse and Individuals with a Disability Page Tobacco Use by Children and Adolescents Page Adolescent Rehabilitation Programs Page A Special Environment Page Prescription Drug Misuse Page Addiction and the Family Unit Page Enabling Page Codependency Page Reactions to the Concept of Codependency Page Definitions Page Psychopathology and Drug of Choice Page III.
Page Psycho-Educational Intervention Programs Page Spirituality Page Diseases of the Spirit Page The Benefits of Spirituality Page The Addictions as a Disease of the Spirit Page Screening Page Assessment Page The Assessment Format Page Diagnostic Rules Page Chapter Intervention Page A Brief History of Intervention Page The Mechanics of Intervention Page The Ethics of Intervention Page Some Common Forms of Intervention Page Chapter Treatment Settings Page An Introduction to Outpatient Treatment Page Introduction to Residential Treatment Programs Page Aftercare Programs Page Characteristics of the Substance Rehabilitation Professional Page The Treatment Plan Page Chapter The Process of Treatment Page Methods of Treatment Page The Stages of Recovery Page Common Problems Page Switching Addictions Page Lapse and Relapse Page Pain Page Controlled Drinking Page "Cravings" and "Urges" Page The "Using" Dream Page Toxicology Testing Page Funding Page Elements of AA Page Alcoholics Anonymous and Outside Organizations Page Other Step Groups Page Challenges to the Traditional Step Movement Page The Pneumonias Page Tuberculosis Page Viral Hepatitis Page Harry Anslinger Page Adulterants Page "Designer" Drugs Page Some Existing Drug Analogs Page Designer Narcotics Page Atypical Compounds of Misuse Page Chapter The Debate over Legalization Page The Reality of the War on Drugs Page The Debate over "Medical Marijuana" Page Legalization of Marijuana Page Appendix 2: Drug Classification Schedules Page Glossary Page References Page Index Page Copyright Cengage Learning.
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In loving memory of Harold Doweiko. For Jan. Preface The world of the neurosciences is constantly changing. Many long-cherished theories have been discarded, while new information leads to the formation of new theories, or suggests new directions for theoretical inquiry. It is now understood that while glial cells do indeed carry out this function, they also play a role in the process of neurogenesis and, as was recently discovered, are involved in a form of neurotransmission that both parallels and is independent of the neuron neural networks in the brain.
Over the years, there have been a number of changes made to this text, and this process has continued with the current edition.
Information about the synthetic THC-like compounds that became popular drugs of misuse in the first months of this decade have also been reviewed. Several of the chapters have been rewritten in an attempt to avoid duplication of material. Out of curiosity I tried to count every change made to the manuscript from the addition or deletion of a reference to the addition of new material and deletion of material not thought relevant, movement of a section to another part of a chapter so that it would be more appropriate there, etc.
Over the years, several instructors have contacted the author to inquire about the chapter sequence decisions. It is difficult to write a text that will be used across a range of diverse fields of study in the order that will meet the demands of each class psychology, sociology, nursing, and substance misuse counseling, to name a few of the college classes that have used earlier editions of this text.
I do believe that it is important to review the drugs of misuse and their effects first so that the student might understand why the misuse of these compounds is so appealing.
Substance misuse is a different reality than the one taught in nursing schools, psychology programs, sociology programs, or even medical school.
On more than one occasion the author of this text has been approached by a trauma surgeon to explain why a person would knowingly expose themselves to doses of anabolic steroids, and how this would affect their behavior. On many occasions, students or seminar participants have expressed surprise at some of the contaminants or adulterants found in illicit drugs. Trying to explain that for the person addicted to 1 Discussed in the chapter on amphetamine misuse and addiction. For these reasons the author of this text has adopted the philosophy that to understand and treat substance use disorders, you need to first understand the chemicals being misused and their effects.
Acknowledgments It is not possible to thank all of those people who have provided so much support during the preparation of this edition. I would like to thank Dr. David Metzler for his willingness to part company with many copies of various journals over the years. This allowed me access to many of the references cited in this text, and his kindness is appreciated.
In addition, I would like to thank in addition, I would like to thank Dr. Amelia Evans for her invaluable contributions to this edition.
All examples provided are hypothetical in nature. Any resemblance to any person, living or dead, is entirely due to chance and should not be inferred by the reader. Further, the practice of substance misuse counseling or psychotherapy is very complex and the practitioner should be familiar with a wide range of resources in conducting their practice. Neither the author nor the publisher shall be liable or responsible for any harm, loss, or damage allegedly arising from any information or suggestion made in or omitted from this text.
Some researchers speak with great authority about persons with a SUDs, demonstrate increased or decreased activity in the brain as measured by one parameter or another when under the influence of chemicals, or show that certain genes are activated or deactivated in critical phases of development significantly more often in those persons with a SUDs than in the general population, as if these things caused the chemical use problem.
Such things might reflect contributing factors but might equally be the end result of the SUDs itself. However, the most important point is the SUDs involves not nameless statistics in journal or newspaper articles, but people. Whether directly or indirectly, SUDs affect each of us Hari, Individuals who misuse prescription drugs fall under the rubric of having an SUD, but often are able to successfully hide their prescription drug use from others because their drugs were prescribed by a health care professional.
A subgroup of individuals who misuse substances indulge in infrequent use of illegal drugs such as the hallucinogens, cocaine, illicit narcotics, and marijuana. The increasing use of social media allows potential customers to arrange to meet their suppliers at mutually agreed upon locations to carry out their illegal transactions. Alcohol and nicotine and in some states marijuana hold a unique position in this process: Their use is legal for persons over a certain age, and the level of alcohol or tobacco use has remained relatively constant in spite of widespread knowledge of the physical, social, and financial toll that the use of these compounds causes.
Additionally, marijuana continues to gain acceptance in many states, not only for medicinal use, but for personal recreational use as well. There have been 1 This number excludes those persons who lose their lives to tobacco- or alcohol-related illness. Further, many of the steroid compounds being misused were not intended for use by humans, but were designed for use with animals and diverted to the illicit market or manufactured in illicit laboratories.
A person might belong to more than one subgroup simultaneously or move from one subgroup to another over time. Although alcohol and tobacco are legal, they do share one characteristic with the other drugs that are misused: They exact a terrible cost on the individual and society.
In this chapter, we will begin to examine the impact of SUDs on society and the individuals who make up that society. The cost of providing health care for the families of those convicted of drug-related offenses becomes part of the Department of Human Services budget, and so on Cafferty, In the 21st century, the rising cost of health care in the United States has become hotly debated.
Approximately one million hospital emergency room visits are the result of illicit drug use Centers for Disease Control and Prevention, b. Hospitalized persons with a SUDs are more likely to require rehospitalization within 30 days of discharge than nonusers Walley et al. Neurological damage that is apparently induced by long-term heroin abuse appears to continue for at least three years after the individual discontinues the abuse of the substance8 Zou et al.
SUDs and interpersonal violence: There is a welldocumented relationship between SUDs and violent behavior that has remained relatively constant over the years. Yet ongoing research is needed to fully understand the impact of SUDs and violence United Nations, Researchers have found that adults misusing substances are 2. Forty percent of homicide victims across 17 states were found to have alcohol in their systems Naimi et al. The majority of those who use a psychoactive substance do so on a short-term experimental 8 7 The discrepancy between these two figures is explained by the fact that many of those who commit suicide consume alcohol as a way to steel their courage before taking their lives, while others commit suicide impulsively while intoxicated.
The majority of those individuals who are actively addicted to chemicals fail to receive any form of treatment, according to the authors. A thriving black market,10 which is further aided by the availability of drugs via internet sources including the dark net, has evolved around the world to meet the demand for illicit drugs11 created by those misusing substances or by those who are addicted to one or more chemicals.
In spite of strict legal sanctions, this distribution system is quite resilient. Keep in mind that it is possible for an individual to be in two or all three of the categories listed above. Many of these individuals will probably only experiment with illicit drugs out of curiosity for under 12 months12 and then discontinue or curtail further use of that compound Center for Substance Abuse Research, The second figure still means that close to 5 million people over the age of 12 misused an illicit compound other than marijuana in the 10 See Glossary.
Or illegal alcohol to minors or in areas where alcohol use is prohibited. An interesting research study methodology utilized by Banta-Greene and colleagues tested waste water from both rural and urban areas and found measurable amounts of cocaine and methamphetamine metabolites, underscoring the widespread misuse of these compounds in this country.
In the next section, we will more closely examine the scope of the problem of SUDs in this country. For most of these people, alcohol will not become a problem in any sphere of their lives.
However, between 8 and 16 million persons in the United States do become physically dependent on alcohol, while another 5. This may underestimate the total number of persons with an alcohol use disorder, since many high-functioning persons with an alcohol use disorder are able to successfully hide the fact from friends, family, and coworkers, possibly for decades Benton, For the average person, alcohol might represent a pleasant diversion from the stress of daily living; however, a minority of those who drink consume a disproportionate amount of the alcohol produced.
If their drinking has resulted in their suffering social, physical, emotional, or vocational consequences,13 then they may have an AUD. These figures underscore the danger of alcohol use and misuse in spite of its legal status as a socially acceptable recreational compound for adults. Globally, it has been estimated that In the United States, current estimates suggest that approximately 5 million people have used heroin at some point in their lives and that there are over , with a heroin use disorder SAMHSA, , Unfortunately, heroin is only one of a wide range of opioids that might be obtained and misused.
An estimated 1. The problem of medication diversion is an ongoing one in the United States, with the result that many individuals addicted to opiates support their opioid misuse almost exclusively on prescribed medications obtained either from a physician or from illicit sources. Thus, the estimates above underestimate the total number of people addicted to an opiate in this country by an unknown margin.
About 1. As it is true for narcotic analgesics, an unknown percentage of prescribed CNS stimulants is diverted to the illicit market, providing a pool of unrecognized individuals who rely on these stimulants. Estimates of the Problem of Cocaine Misuse and Cocaine Use Disorder The number of individuals who use or are addicted to cocaine in the United States has actually gone down in recent years 15 The topic of opioid misuse is discussed in Chapter This topic is discussed in more detail in Chapter 8.
Globally, approximately In this country, it has been estimated that there are close to 2 million people who use cocaine monthly, and close to 40 million people who have used it at some point in their lives SAMHSA, , It is estimated that 1.
Estimates of the Problem of Tobacco Use and Tobacco Use Disorder Tobacco is a special product: It can be legally purchased by adults, yet it is acknowledged to be destructive and addictive.
In this text it will be classified as a hallucinogen. See Chapter 12 for more details on this issue. Unfortunately, tobacco products are easily available to adolescents, and in some cases to children. More than one billion people in the world smoke tobacco, yet tobacco kills more than 7 million people each year World Health Organization, Researchers estimate that approximately All the estimates cited in the last paragraph are in addition to the 20 million Americans who have died since from tobacco-related causes U.
Department of Health and Human Services, Further, approximately , people die each year in the United States due to chronic or acute alcohol use Centers for Disease Control and Prevention, The Cost of Tobacco Use Disorders Although it is legally produced, purchased, and used by adults without restriction, tobacco use extracts a terrible toll around the globe. When the cost of disability, accidental injuries, health care, and absenteeism from work are added together, the total economic impact of the SUDs on the U.
The various state governments spend only two cents of every dollar on programs devoted to the prevention and treatment of persons with a SUDs CASA, ; Grinfeld, Health care professionals in general are woefully ill-prepared to work with those who misuse substances. Further, most physicians emerge from graduate training with a negative attitude toward individuals with an SUD Renner, a. Brown, , p. Physician postgraduate educational programs have attempted to address this problem; however, the average length of such training in addictions is only about 8 hours Renner, a.
Nor is this professional blindness limited to physicians. Thus, those health professionals who will have the most contact with the patient—the nursing staff—are as ill-prepared to work with patients with SUDs as is the average physician. Marriage and family therapists are another group of health care professionals who, as a whole, are ill prepared to recognize, much less deal with, SUDs.
Such problems are rarely identified, meaning that vital clues to the nature of the disorder within the family are missed, and therapy might be rendered ineffective.
If these disorders are identified, they are usually addressed by a referral to a therapist of another discipline than marriage or family therapy. Further, if there is a co-occurring disorder situation SUDs with co-occurring mental illness there is a definite need for family therapy, but this is rarely initiated Minkoff, Only professional substance abuse counselors are required to have a high level of professional training in the recognition and treatment of SUDs, with national standards for individuals working in this field having only recently been established.
Designer Drugs for Pleasure: A Frightening Brave New World There has been virtually no research into drugs whose purpose is to treat a disease but which induce a sense of pleasure or euphoria enjoyed by the patient Morris, Pharmaceutical companies are now hard at work to correct this oversight, drawing upon the latest research into the manner in which the reward cascade works.
It is impossible to predict when, but soon a new class of pharmaceuticals whose sole purpose is to induce a sense of pleasure in the user will appear on the market. The addiction potential of such chemicals is readily apparent, and raises a philosophical question: Does society have the right to block public access to such recreational chemicals?
Would this not introduce a new class of illicit chemicals into society, setting the groundwork for the growth of illicit distribution networks such as those seen for alcohol during the Prohibition era or the wave of methamphetamine use seen in the last decade of the 20th century and the first part of the 21st century?
How should society respond to the hypothetical introduction of this new class of chemicals? Chapter Summary The problems of excessive alcohol use and illicit drug use have plagued society for generations. Solutions to the problem of the SUDs that have been shown to be inadequate include: banishment, execution, castration, incarceration, religious intervention, and various form of treatment.
One example of this might be seen in the extensive pool of data on the effects of pharmaceuticals, including therapeutic threshold, therapeutic and elimination halflives, and side effects of compounds based on multi-participant research studies, and a lack of similar data on the drugs of misuse beyond what can be extrapolated from animal studies and anecdotal case reports. The desire to become intoxicated is not unique to humans: Biologists have documented episodes in which at least some mammals appear to intentionally seek out fermented fruits or mushrooms that contain compounds that can bring about a state of intoxication.
Many such episodes have been captured on film or electronic media and are available for viewing as public entertainment on the internet.
Domestic cat owners have supplied their pets with catnip, often doing so on a regular basis, much to the delight of their four-legged family members. It would appear that we share the desire to chemically alter our perception of the world with our mammal cousins. The American Society of Addiction Medicine ASAM has suggested a model of substance use disorders that attempts to integrate the biological, psychological, and sociological theories of addiction into one unified model.
These attitudes are explicit both in contemporary medical literature and in popular, self-help texts. We categorise addiction as unnatural, diseased and self-destructive.
We demonise pleasure and desire, and view the addict as physically and morally damaged. Helen Keane's thought-provoking text examines these assumptions in a new light. In asserting that the 'wrongness' of addiction is not fixed or indeed obvious, she presents a refreshing challenge to more conventional accounts of addiction. She also investigates the notion that people can be addicted to eating, love and sex, just as they are to drugs and alcohol. What's Wrong with Addiction?
It exposes strains in our society's oppositions between health and disease, between the natural and the artificial, between order and disorder, and between self and other. This book is a basic resource of knowledge about alcoholism and drug addiction. The authors cover the scientific and clinical aspects of chemical dependency in a balanced way with case vignettes to illustrate clinical issues. The book is suitable for a number of student needs.
Students preparing for the Certified Alcoholism and Substance Abuse Counselor CASAC examination will find topics discussed that are drawn from the certification examination requirements. The text can stand as a main source for college-level courses in addictions or chemical dependancy in the mental health health programs, and can be used as a college or stand-alone introduction to chemical dependancy and counseling.
Psychologists, social workers, clergy, and other professional counselors who wish to supplement their knowledge about chemical dependancy will find this text serves as a valuable reference.
After an introduction to the general problems of substance abuse counseling, the authors delineate the different types of drugs and their effects, organize the relevant information used in the assessment and diagnosis of addictions, integrate knowledge of human development with causes of dependancy and addiction, and explore the impact of addiction on health and the family.
They then focus on the principles of chemical abuse counseling, including treatment planning, the different schools of counseling, how to understand and manage relapse, and special populations. They conclude with ethical considerations involved in treating chemical abusers.
The authors believe that chemical dependency counseling is the only profession that treats substance abuse as a primary disorder and disease with its own causes, course, progression and complication. Chemical dependency counseling must deal with and absorb a complex and intriguing web of fact and theory drawn from sciences, medicine, and other fields. But the practical side of chemical dependency counseling remains an art and a science. This book offers a whole set of specific techniques.
The newest addition to the popular Quick-Reference Guide collection, The Quick-Reference Guide to Addictions and Recovery Counseling focuses on the widespread problem of addictions of all kinds. It is an A-Z guide for assisting pastors, professional counselors, and everyday believers to easily access a full array of information to aid them in formal and informal counseling situations.
Each of the forty topics covered follows a helpful eight-part outline and identifies 1 typical symptoms and patterns, 2 definitions and key thoughts, 3 questions to ask, 4 directions for the conversation, 5 action steps, 6 biblical insights, 7 prayer starters, and 8 recommended resources.
From its helpful pages that contain diagnostic criteria and clinical interviewing and assessment guidelines, you learn to accurately diagnose substance use and antisocial personality disorders.
The book also provides you with the historical and clinical perspectives of such disorders and their epidemiology and etiology to give you a thorough background and understanding of the subject. Case studies and therapy vignettes are included to provide you with actual clinical examples to illustrate concepts and ideas.
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