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• Cover Page
• Title Page
• Copyright Page
• Dedication
• Preface
• Chapter 1. Why Worry About Substance Misuse or Substance Use Disorders (SUDs)?
  • SUDs as Unsuspected Influences on Society
  • The Scope of the Problem of the SUDs
    • Alcohol Use, Misuse, and Alcohol Use Disorder
    • Estimates of the Problem of Opioid Misuse and Opioid Use Disorder
    • Estimates of the Problem of Stimulant Misuse and Stimulant Use Disorder
    • Estimates of the Problem of Cocaine Misuse and Cocaine Use Disorder
    • Estimates of the Problem of Cannabis Use, Misuse, and Cannabis Use Disorder
    • Estimates of the Problem of Hallucinogen Misuse
    • Estimates of the Problem of Tobacco Use
  • The Cost of Chemical Misuse and SUDs
    • The Cost of Alcohol Use/Misuse/AUD
    • The Cost of Tobacco Use Disorders
    • The Cost of SUDs
  • Who Treats Persons with an SUD?
  • Designer Drugs
  • Chapter Summary
• Chapter 2. The Nature of the Beast
  • Why Do People Choose to Use Drugs or Alcohol?
  • Drug Use/Misuse Cycles
  • The Continuum of Chemical Use
  • What Do We Mean When We Say That Somebody Is “Addicted” to a Chemical?
  • Definitions of Terms Used in This Text
  • Process Addictions
  • Unanswered Questions
  • Chapter Summary
• Chapter 3. A Brief Introduction to the Science of Pharmacology
  • A Basic Misconception
  • The Prime Effect and Side Effect of Chemicals
  • The Method by Which a Compound Is Administered
    • Typical Forms of Drug Administration
  • Bioavailability
    • Absorption
    • Distribution
    • Transport
    • Biotransformation
    • Elimination
    • Drug Half-Life
  • Drug Interactions
  • The Effective Dose
  • The Lethal Dose and Therapeutic Index
  • Therapeutic Threshold and Peak Effects
  • Potency
  • Tolerance
  • The Site of Action
  • The Receptor Site
  • The Process of Neurotransmission
    • Neurotransmitters
    • Neurotransmitter Reuptake/Destruction
    • Co-Transmission
    • Up-/Down-Regulation of Receptor Sites
    • Drug Agonists/Antagonists
  • The Blood-Brain Barrier
  • Chapter Summary
• Chapter 4. An Introduction to Alcohol: Man’s Oldest Recreational Chemical
  • Why Do People Consume Alcohol?
  • A Brief History of Alcohol
  • Alcohol Today
    • How Alcoholic Beverages Are Produced Today
  • A Working Definition of Social Drinking
  • Scope of Alcohol Use in the World Today
  • The Pharmacology of Ethyl Alcohol
  • The Biotransformation of Alcohol
    • The Speed of Alcohol Biotransformation
    • The Alcohol-Flush Reaction
  • The Blood Alcohol Level (BAL)
  • Subjective Effects of Alcohol on an Individual Who Drinks Socially at Normal Doses
    • Powdered Alcohol
  • Medical Complications of Alcohol Use for the Individual Who Drinks Socially
    • A Note of Caution
    • A Speedy Recovery
    • The Hangover
    • The Effects of Alcohol on the Cardiovascular System
    • The Effects of Alcohol on the Immune System
    • The Effects of Alcohol on the Gastrointestinal Tract
    • The Effects of Alcohol on Sleep for the Individual Who Drinks Socially
    • Social Drinking and Stroke
    • Alcohol Use and Neurocognitive Effects
    • Other Consequences of Rare/Social Drinking
    • Paradoxical Rage Reaction
    • Drug Interactions Involving Social Alcohol Use
    • Alcohol Ingestion and Injury
  • Alcohol Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 5. The Alcohol Use Disorders
  • A Working Definition of the Alcohol Use Disorders
  • Scope of the Problem
  • Who Is the Typical Person with an Alcohol Use Disorder?
  • Physical Dependence, Tolerance, and “Craving”
  • Complications of Chronic Alcohol Use
    • The Effects of Chronic Alcohol Use on the Digestive System
    • The Effects of Chronic Alcohol Use on the Liver
    • Effects of Chronic Alcohol Use on the Circulatory System
    • The Effects of Chronic Alcohol Use on the Central Nervous System (CNS)
    • Wernicke-Korsakoff Syndrome
    • Alcohol’s Effects on the Sleep Cycle
    • The Effects of Habitual Alcohol Use on the Peripheral Nervous System
    • The Effects of Alcohol Use Disorders on the Individual’s Emotions
    • The Effects of Habitual Alcohol Use on the Respiratory System
    • The Effects of Chronic Alcohol Use on Other Body Systems
  • Chronic Alcohol Use and Medication Abuse
  • The Alcohol Withdrawal Syndrome
    • Extended Alcohol Withdrawal
  • Alcohol Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 6. Misuse of Barbiturates and Barbiturate-Like Compounds
  • Early Medical Treatment of Anxiety and Insomnia
  • History and Current Medical Uses of Barbiturates
  • The Prevalence of Misuse of the Barbiturates
  • Pharmacology of the Barbiturates
  • Subjective Effects of Barbiturates at Normal Dosage Levels
  • Complications of Barbiturate Use at Normal Dosage Levels
    • Drug Interactions Involving Barbiturates
  • Effects of the Barbiturates at Above-Normal Dosage Levels
  • Neuroadaptation, Tolerance, and Physical Dependence on Barbiturates
  • The Barbiturate-Like Drugs
  • Barbiturate Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 7. Use and Misuse of the Benzodiazepines and Similar Agents
  • Scope of Prescribed Benzodiazepine Use
  • Medical Uses of the Benzodiazepines
  • The Pharmacology of the Benzodiazepines
  • Subjective Effects of Benzodiazepines at Normal Dosage Levels
    • Benzodiazepines and Suicide Attempts
  • Side Effects of the Benzodiazepines When Used at Normal Dosage Levels
    • Neurocognitive Impairment
  • Neuroadaptation to and Misuse of Benzodiazepine, and Benzodiazepine Use Disorder
    • Benzodiazepine Misuse
  • Drug Interactions Involving Benzodiazepines
  • Long-Term Consequences of Chronic Benzodiazepine Use
    • Section Summary
  • The Benzodiazepine Receptor Antagonists (Z-Compounds or BRAs)
    • Buspirone
    • Zolpidem
    • Zaleplon
    • Eszopiclone
    • Ramelteon
    • Flunitrazepam
  • Sedative, Hypnotic, or Anxiolytic Use Disorders and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
• Chapter 8. Use and Misuse of Central Nervous System Stimulants
  • CNS Stimulants as Used in Medical Practice
    • The Amphetamine-Like Drugs
    • The Amphetamine Compounds
    • Subjective Experience of Amphetamine Use in Medical Practice
    • Challenges to the Use of CNS Stimulants to Treat Identified Disorders
  • CNS Stimulant Misuse
    • Scope of the Problem
    • Methods of CNS Stimulant Misuse and Their Effects
  • CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
• Chapter 9. Cocaine Misuse and Cocaine Use Disorder
  • A Brief History of Cocaine
    • Cocaine in U.S. History
  • Current Medical Uses of Cocaine
  • Scope of the Problem of the Cocaine Use Disorders
  • Pharmacology of Cocaine
    • Drug Interactions Involving Cocaine
  • How Illicit Cocaine Is Produced
  • Methods of Cocaine Misuse
    • Insufflation
    • Intravenous Cocaine Administration
    • Sublingual Cocaine Misuse
    • Rectal Cocaine Misuse
    • Cocaine Smoking
    • Gastrointestinal Absorption
  • Subjective Effects of Misused Cocaine
  • Complications of Cocaine Misuse and Cocaine Use Disorder
    • Death
    • Addiction
    • Respiratory System Problems
    • Cardiovascular System Damage
    • Cocaine Misuse as a Cause of Digestive System Damage
    • Cocaine Misuse as a Cause of Central Nervous System Damage
    • Cocaine’s Effects on Emotions and Perceptions
    • Other Problems Associated with Cocaine Misuse
    • Cocaine Withdrawal
  • CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
• Chapter 10. Cannabis Use, Misuse, and Cannabis Use Disorder
  • A History of Cannabis Use/Misuse
  • Anecdotal Claims of Efficacy
  • A Question of Potency
  • A Technical Point
  • Scope of the Problem
  • The Pharmacology of Cannabis
    • Interactions Between Cannabis and Other Chemicals
  • Methods of Cannabis Use
  • Subjective Effects of Cannabis Use
  • Adverse Effects of Cannabis Misuse
    • Dangers of Cannabis Misuse: An Ongoing Debate
    • Known and Suspected Adverse Effects of Cannabis Misuse
    • Cannabis-Induced Violence
    • Cannabis Use Disorder
    • Cannabis Withdrawal Syndrome
  • Cannabis Use and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
  • Note
• Chapter 11. Opioid Use, Misuse, and Opioid Use Disorder
  • A Short History of the Natural and Synthetic Opioids
  • I. The Medical Applications of Opioids
    • The Classification of Opioids
    • The Problem of Pain
    • Where Opium Is Produced
    • Current Medical Uses of Opioids
    • Pharmacology of the Opioid Medications
    • Non-Opioid Analgesics
    • Peripheral Mu Opioid Receptor Antagonists
    • Neuroadaptation to Opioids
    • Subjective Effects of Opioids When Used in Medical Practice
    • Complications Caused by Opioids When Used in Medical Practice
    • Section Summary
  • II. Opioids as Drugs of Misuse
    • Why Do People Misuse Opioids?
    • The Mystique of Heroin
    • Other Opioids of Misuse
    • Methods of Opioid Misuse
    • Sources of Illicit Opioids
    • The Development of Tolerance
    • Scope of the Problem of Opioid Misuse and Opioid Use Disorders
    • Complications Induced by Opioid Misuse or Opioid Use Disorder
    • Overdose of Illicit Opioids
  • Opioid Use or Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
• Chapter 12. Hallucinogen Misuse
  • A Short History of Hallucinogens
  • Scope of the Problem
  • Pharmacology of the Hallucinogens
  • Methods of Misuse
  • The Pharmacology of LSD
  • The Subjective Effects of LSD
    • The “Bad Trip”
    • The LSD “Flashback”
    • Drug Interactions Involving LSD
    • Section Summary
  • Phencyclidine (PCP)
    • Scope of Phencyclidine Misuse
    • Methods of PCP Administration
    • Subjective Experience of PCP
    • The Pharmacology of PCP
  • Complications of PCP Use
    • PCP Use as an Indirect Cause of Death
  • Ecstasy/Molly (MDMA)
    • Prevalence of PCP Use Compared to MDMA
    • A Short History of Ecstasy (MDMA)
    • Scope of MDMA Misuse
    • Patterns of MDMA Misuse
    • Pharmacology of MDMA
  • Subjective and Objective Effects of MDMA Use
  • Complications of MDMA Misuse
    • MDMA-Related Cardiac Problems
    • MDMA-Related Neurological Problems
    • MDMA-Related Emotional Problems
    • MDMA-Related Gastrointestinal Problems
    • Other MDMA-Related Problems
    • Medication Interactions Involving MDMA
  • Salvia Divinorum
  • PCP and Hallucinogen Use and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision
  • Chapter Summary
• Chapter 13. Misuse of Inhalants and Aerosols
  • A Brief History of Inhalant Use
  • The Pharmacology of the Inhalants
  • Scope of the Problem of Inhalant Misuse
  • Methods of Inhalant Misuse
  • Subjective Effects of Inhalants
  • Complications Induced BY Inhalant Misuse
    • Inhalant Misuse and Suicide
  • Anesthetic Misuse
    • Nitrous Oxide
  • The Misuse of Nitrites
  • Inhalant Misuse and The Diagnostic and Statistical Manual of Mental Disorders , 5th Edition Text Revision
  • Chapter Summary
• Chapter 14. The Under-Recognized Problem of Steroid Misuse
  • An Introduction to the Anabolic-Androgenic Steroids
  • Medical Uses of Anabolic Steroids
  • Why Steroids are Misused
  • The Legal Status of Anabolic Steroids
  • Scope of the Problem of Steroid Misuse
  • Pharmacology of Anabolic-Androgenic Steroids
  • Sources and Methods of Steroid Misuse
  • The Unknown Hazards of Steroid Misuse
  • Known Adverse Effects of Anabolic Steroids When Misused
    • On the Reproductive System
    • Effects of Anabolic Steroid Misuse on the Liver, Kidneys, and Digestive System
    • Anabolic Steroid Misuse and the Cardiovascular System
    • Steroid Misuse and the Central Nervous System
    • Other Steroid-Related Disorders
    • Drug Interactions Between Anabolic Steroids and Pharmaceuticals
  • Are Anabolic Steroids Addictive?
  • Are Misused Steroids Effective?
  • Anabolic Steroid Use Disorder and The Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 15. Tobacco Products and Tobacco Use
  • A Very Short History of Tobacco Use
  • Scope of the Problem of Tobacco Use
  • The Pharmacology of Tobacco
    • Electronic Nicotine Delivery Systems (ENDS)
    • Nicotine
    • Acetaldehyde
    • Drug Interactions Between Nicotine and Other Substances
  • The Effects of Nicotine on the Body
    • Dependence on Nicotine
    • Nicotine Withdrawal
  • Complications of Long-Term Use of Tobacco Products
    • The Mouth, Throat, and Pulmonary System
    • The Digestive System
    • The Cardiovascular System
    • The Skin
    • The Central Nervous System
    • The Reproductive System
    • Other Complications Associated with Cigarette Smoking
    • Additives
    • Degrees of Risk
    • Smokeless Tobacco
  • Secondhand Smoke
  • Smoking Cessation
    • Cigarette Cessation and Weight Gain
  • Tobacco Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 16. Over-the-Counter Analgesics
  • A Short History of the OTC Analgesics
    • The Origins of the Term NSAID
  • Medical Uses of the OTC Analgesics
    • Aspirin
    • Acetaminophen/Paracetamol
    • The Propionic Acids
  • Normal Dosage Levels of the OTC Analgesics
    • Aspirin
    • Acetaminophen/Paracetamol
    • Ibuprofen
    • Naproxen
  • Pharmacology of OTC Analgesics
    • Aspirin
    • Acetaminophen/Paracetamol
    • Ibuprofen
    • Naproxen
  • Complications Caused by OTC Analgesic Use
  • Acetaminophen/Paracetamol
    • Medication Interactions Involving Acetaminophen/Paracetamol
    • Aspirin
    • Medication Interactions Involving Aspirin
    • Ibuprofen
    • Medication Interactions Involving Ibuprofen
    • Naproxen
    • Medication Interactions Involving Naproxen
  • OTC Overdoses
    • Acetaminophen/Paracetamol
    • Aspirin
    • Ibuprofen
    • Naproxen
  • Over-the-Counter Analgesic Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text Revision)
  • Chapter Summary
• Chapter 17. Chemicals and the Neonate
  • Scope of the Problem
    • A Period of Special Vulnerability
  • Alcohol
    • Scope of the Problem
    • Consequences of Maternal Alcohol Use
    • Other Consequences of Maternal Alcohol Use
    • Breastfeeding and Alcohol Use
    • Medication for Alcohol Use Disorder During Pregnancy
  • Use of Amphetamines and Amphetamine-Like Compounds During Pregnancy
    • Amphetamine Use and Breastfeeding
  • Barbiturate and Barbiturate-Like Drug Use During Pregnancy
  • Benzodiazepine Use During Pregnancy
    • Benzodiazepine Use During Breastfeeding
    • Buspirone Use During Pregnancy
  • Tobacco Use During Pregnancy
    • Prenatal Exposure to Environmental Tobacco Smoke
    • Maternal Use of Electronic Nicotine Delivery Systems (ENDS)
    • Smoking and Breastfeeding
    • Nicotine Replacement Therapy (NRT) During Pregnancy
    • Tobacco Cessation Medication Use During Pregnancy
  • Cocaine Use During Pregnancy
    • Cocaine and Breastfeeding
  • Hallucinogen Use During Pregnancy
    • LSD Use During Pregnancy
    • MDMA Use During Pregnancy
    • PCP Use During Pregnancy
    • Salvia Divinorum Use During Pregnancy
  • Inhalant Misuse During Pregnancy
  • Cannabis Use During Pregnancy
    • Cannabis and Breastfeeding
  • Opioid Use During Pregnancy
    • Statement of the Problem
    • Maternal Opioid Misuse and Breastfeeding
  • Over-the-Counter Analgesic Use During Pregnancy
    • Aspirin
    • Acetaminophen/Paracetamol
    • Ibuprofen
  • Caffeine During Pregnancy
  • Chapter Summary
• Chapter 18. Gender and Substance Use Disorders
  • Gender and Addiction: The Lessons of History
    • Statement of the Problem
  • Substance Use Disorders in Women
  • Does Gender Affect the Rehabilitation Process?
    • Work, Gender, and Substance Use Disorders
  • Differing Effects of Common Drugs of Misuse on Women
  • Alcohol Use Disorders in Women
    • Physical Complications
    • Interpersonal Resources
    • A Positive Note
    • A Cautionary Note
  • Amphetamine Use Disorders in Women
  • Benzodiazepine Misuse by Women
  • Buspirone Misuse by Women
  • Cocaine Misuse by Women
  • Hallucinogen Misuse by Women
    • Ecstasy (MDMA)
    • LSD and Phencyclidine
  • Cannabis Misuse by Women
  • Opioid Misuse by Women
  • Nicotine Use by Women
    • Smoking Cessation
  • Other Compounds
    • Aspirin
  • Chapter Summary
• Chapter 19. Hidden Faces of Substance Use Disorders
  • Substance Use Disorders and People Experiencing Homelessness
  • Substance Use Disorders in the Military
  • Combat Veterans and Substance Use Disorders
  • Substance Use Disorders in Sexual and Gender Minorities
  • Substance Misuse and Individuals with a Disability
    • Traumatic Brain Injuries
  • Ethnicity and Substance Use Disorders
    • Native Americans
    • Latinx Clients
    • Asian Americans
    • African Americans
  • Chapter Summary
• Chapter 20. Substance Misuse by Children and Adolescents
  • The Problem of Substance Use and Substance Use Disorders in Childhood and Adolescence
    • A Complicating Factor
  • Scope of the Problem of Substance Use in Childhood and Adolescence
    • Childhood and Adolescent Substance Use Patterns
  • Why Worry About Substance Use Disorders in Childhood and Adolescence?
    • The Neurological Factor
    • The “Gateway” Theory
  • Tobacco Use by Children and Adolescents
    • Stages of Childhood/Adolescent Smoking
  • Why Do Children and Adolescents Use Chemicals?
    • Racial/Ethnic Group Membership
    • Gender Differences
    • Parental–Adolescent Relationship Patterns
    • Siblings
    • Vocational/Occupational Choices
    • Adolescent Mood States
    • Conduct Disorder/Oppositional Defiant Disorder
    • Peer Group Influences
    • Telecommunications
    • Religious Affiliation
    • Music Selection
    • Personal Values
    • Rebellion
    • Insomnia
    • Abuse History or Victimization
    • Employment
    • Section Summary
  • Substance Use: How Much and When Does It Become Too Much?
    • Prevention
    • Childhood
    • Adolescents
    • Stages of Adolescent Substance Use
    • Adolescent Addiction to Chemicals
    • Problems in Diagnosis and Treatment of Adolescent SUDs
  • Screening/Assessment Tools
    • Screening Instruments
  • Possible Diagnostic Criteria for Children or Adolescents with Suspected SUDs
    • Children
    • Adolescents
  • Consequences of a Substance Use Disorder in a Child or Adolescent
    • Alcohol
    • Benzodiazepines
    • Cocaine
    • Hallucinogens
    • Inhalants
    • Cannabis
    • Methamphetamine
    • Tobacco
    • Opioids
    • Other Compounds Misused by Children and Adolescents
  • Adolescent Treatment Programs
    • The Special Needs of Adolescent Substance Treatment Programs
    • Referral Sources
    • Adolescent Substance Use Treatment: A Cause for Optimism?
    • Is There a Financial Incentive for Over-Diagnosis?
    • The Danger of Under-Diagnosis
  • Chapter Summary
• Chapter 21. Substance Use and Substance Use Disorders in College Students
  • Why Worry About College Substance Use?
  • A Special Environment
    • Peer Relationships
    • An Evolving Relationship
  • Scope of the Problem
    • Group Insulation
  • Consequences of Substance Use Disorders in the College Population
    • Binge Drinking
    • Energy Drinks
    • CNS Stimulants
    • Tobacco Use
    • Illicit Drug Use
    • Intervention
  • Post-Graduation and Graduate School
  • Are There Forces That Help Protect the Student from SUDs?
  • Chapter Summary
• Chapter 22. Substance Use Disorders and the Older Adult
  • Scope of the Problem
  • What Are the Consequences of an SUD in the Older Adult?
  • Why Is the Detection of SUDs in Older Adults So Difficult?
  • Different Patterns of Alcohol/Drug Misuse in the Older Adult
  • Prescription Drug Misuse
  • The Treatment of Older Patients with SUDs
  • Adults over 80
  • Chapter Summary
• Chapter 23. Substance Use Disorders and the Family
  • Scope of the Problem
  • Substance Use Disorder and the Family Unit
    • The Family System Perspective
    • Parental Rules
    • Marriage with a Partner with an SUD
    • Marital Intimacy
    • Financial Stability
    • The Cost of Adolescent SUDs
  • Interventions
  • The Adult Children of Alcoholics (ACOA) Movement
    • The Growth of ACOA Support Groups
    • Criticism of the ACOA Movement
  • Chapter Summary
• Chapter 24. Codependency and Enabling
  • Enabling
  • Codependency
    • Codependency Defined
    • The Relationship Between Enabling and Codependency
    • The Dynamics of Codependency
    • The Rules of Codependency
    • Are Codependents Born or Made?
    • Codependency and Self-Esteem
    • The Cycle of Codependency
    • Patterns of Codependency
    • The Relationship Between Codependency and Mental Health
  • Reactions to the Concept of Codependency
  • Chapter Summary
• Chapter 25. The Client with Co-Occurring Disorders
  • Definitions
    • Coexisting Substance Use and Medical Disorders
  • Etiology of Co-Occurring Disorders
  • Clients with Co-Occurring Disorders: A Diagnostic Challenge
  • Why Worry About Clients with Co-Occurring Disorders?
  • Scope of the Problem
  • Psychopathology and Drug of Choice
    • Attention Deficit Hyperactivity Disorder (ADHD)
    • Schizophrenia
    • Anxiety Disorders
    • The Dissociative Disorders
    • Obsessive-Compulsive Disorder (OCD)
    • Bipolar Disorders
    • Depression
    • Eating Disorders
    • Gambling Disorder
    • Personality Disorders
    • Antisocial Personality Disorder and Substance Use Disorders
    • Borderline Personality Disorder and SUDs
    • Mixed Personality Disorders
    • Co-Occurring Disorders/Victimization Issues
    • Posttraumatic Stress Disorder
  • Problems in Working with the Client with Co-Occurring Disorders
    • Traumatic Brain Injury and SUDs
    • Post-Concussion Syndrome (PCS)
    • Clients with Co-Occurring Diagnoses and Medication Compliance
  • Treatment Approaches with Clients with Co-Occurring Disorders
    • The Stages of Treatment
    • The Outcome of Treatment
    • Ancillary Issue: Smoking
  • Chapter Summary
• Chapter 26. The Biopsychosocial Model of the Addictions
  • I. Biology: The “Bio” Part of the Bio/Psycho/Social Model
    • Definition
    • History
    • Process
    • Biological Determinism
    • Jellinek’s Work
    • The Genetic Inheritance Theories
    • Epigenetics
    • Neurobehavioral Theories
  • Applications of the Biological Component of the Bio/Psycho/Social Model
  • Reactions Against the Biological Component of the Bio/Psycho/Social Model
    • Philosophical
    • Methodological Considerations
    • Reactions Against the Jellinek Model
    • Genetic Inheritance Theories
    • Reactions to the Epigenetics Model
    • Reactions Against the Dopamine D 2 Receptor Site Hypothesis
    • Biological Vulnerability Studies
    • Challenges to the Neuroplasticity Aspects of the Disease Model
    • Challenges to the Brain Imaging Studies
    • Challenges to the Genetic Modification Treatment Approaches
    • The Medical Model and Individual Responsibility
    • Spontaneous Recovery
    • Section Summary
  • II. The Psychological Components of the Bio/Psycho/Social Model
    • Definition
    • The Moral Model
    • Learning Theory
    • Coping Systems Theory
    • Personality Defense Theories of Substance Use Disorders
    • Behavioral Psychology Theories
    • Cognitive-Behavioral Theories (CBT)
    • Psychoanalysis
    • The Addictive Personality
  • Applications of the Psychological Component of the Bio/Psycho/Social Model
    • Assessment
    • Neuropsychological Assessment
    • Individual or Group Psychotherapy
    • Cognitive Dissonance
    • Couples and Family Therapy
  • Reactions Against the Psychological Models of the Substance Use Disorders
    • Reactions to the Moral Model of the SUDs
    • Reactions to the “Alcoholic” (or “Addictive”) Personality Theories
    • Challenges to the “Characteristic Defenses” Theory
    • Challenges to the Behavioral Psychology Approach
    • Challenges to the Learning Theories of the SUDs
    • Reactions Against the Coping Skills Theories
  • III. The Social Component of the Bio/Psycho/Social Model
    • Definition
    • Overlap with the Biological Model
    • The Role of Substance Use in a Culture
    • Social Factors Influencing Individual Substance Use Decisions
  • Applications of the Social Component of the Bio/Psycho/Social Model
  • Psychoeducational Intervention Programs
  • Reactions to the Bio/Psycho/Social Model
  • Chapter Summary
• Chapter 27. The Substance Use Disorders and Spirituality/Religion
  • The Starting Point
    • Before Spirituality is Self-Awareness
  • Spirituality
  • Modern Spirituality
  • Concerns of the Spirit
    • False Pride
    • Failure to Maintain a Commitment to Your Spiritual Beliefs
    • Punishment
    • Pseudo-Spirituality
    • Denial of Responsibility
    • Open Dishonesty
    • Honesty
    • History of Abuse
  • The Benefits of Spirituality
  • Substance Use Disorders as a Concern of the Spirit
  • Chapter Summary
• Chapter 28. The Screening and Assessment of Suspected Substance Use Disorders
  • Understanding the Purpose of Substance Use Assessments
  • Screening
    • Verbal Screening Aids
    • Paper-And-Pencil/Computerized Screening Instruments
    • Section Summary
  • Assessment
    • Standardized Assessments,
    • Section Summary
  • The Assessment Format
    • Circumstances of Referral
    • Substance Use Patterns
    • Past Treatment History
    • Legal History
    • Past Military Record
    • Educational/Vocational History
    • Developmental/Family History
    • Psychiatric History
    • Medical History
    • Personality Disorder Symptomology
    • Section Summary
    • The Assessor and Data Privacy
  • Diagnostic Considerations
  • Other Sources of Information: Medical Test Data
  • Diagnosis: The Outcome of the Assessment Process
    • Treatment Referrals
  • Chapter Summary
• Chapter 29. Intervention
  • A Definition of Intervention
  • A Brief History of Intervention
  • Characteristics of the Intervention Process
    • Physician-Based Brief Intervention
    • Informal Interventions
  • The Mechanics of Intervention
  • The Ethics of Intervention
  • Some Common Forms of Intervention
    • Family Intervention Projects
    • Intervention BY the Legal System
    • Drug Court
    • Court-Mandated Involuntary Treatment
    • Other Forms of Intervention
    • Employer-Mandated Treatment
  • Reactions Against the Concept of Intervention
  • Chapter Summary
• Chapter 30. Treatment Settings
  • An Introduction to Outpatient Treatment
    • Outpatient Treatment: A Working Definition
    • Components of Outpatient Treatment
    • Varieties of Outpatient Treatment Programs
    • Partial Hospitalization Options
    • Advantages of Outpatient Treatment
    • Disadvantages of Outpatient Treatment Programs
  • Introduction to Inpatient Treatment Programs
    • Definition of Inpatient Treatment
    • Hospital-Based Inpatient Treatment
    • Therapeutic Communities
  • Is There a Legitimate Need for Inpatient Treatment?
    • The Advantages of Inpatient Treatment
    • Disadvantages of Inpatient Treatment
  • Continuing Care Programs
    • Halfway Houses
    • Sober Houses
  • Chapter Summary
• Chapter 31. The Treatment of Substance Use Disorders
  • Characteristics of the Substance Treatment Professional
    • Confrontation and Other Techniques
  • The Minnesota Model of Substance Use Treatment
    • Reaction to the Minnesota Model
  • Other Treatment Formats for Substance Use Disorders
    • Acupuncture
    • Computer Simulations
    • Detoxification
    • Family/Couples Therapies
    • Individual Therapy Approaches
    • Group Therapy Approaches
    • Biofeedback Training
    • Harm Reduction (HR) Model
    • Yoga or Meditation
  • The Treatment Plan
  • Continuing Care Programs
  • The Treatment/Research Disconnect
  • Chapter Summary
• Chapter 32. The Process of Treatment
  • The Decision to Seek Treatment
  • Methods of Treatment
    • Motivational Interviewing
    • Cognitive-Behavioral Therapies
    • Voucher-Based Reinforcement
  • The Stages of Recovery
    • Reactions to Stage Models of Recovery
    • Then What Works in Predicting Recovery from SUDs?
    • Should Abstinence Be the Goal of Treatment?
  • Specific Points to Address in Substance Treatment
    • Alcohol
    • Opioids
    • CNS Stimulants
    • Cannabis
    • Anabolic Steroids
    • Hallucinogens
    • Reactions to the Concept of Substance Use Disorder Treatment
  • Chapter Summary
• Chapter 33. Pharmacological Interventions for Substance Use Disorders
  • The Theory Behind Pharmacotherapy for SUDs
  • Pharmacological Treatment of Alcohol Use Disorders
    • Pharmaceutical Treatment of the Alcohol Withdrawal Syndrome (AWS)
    • Pharmacological Treatment of the Alcohol Use Disorders
    • Disulfiram
    • Section Summary
  • Pharmacological Treatment of Stimulant Use Disorders
    • Bupropion
    • Mirtazapine
    • Modafinil
    • Naltrexone
    • Topiramate
  • Pharmacological Treatment of Inhalant Use Disorders
  • Pharmacological Treatment of Cannabis Use Disorders
  • Pharmacological Treatment of Opioid Use Disorders
    • Medications to Treat Opioid Overdose
    • Compounds to Treat Opioid Withdrawal
    • Experimental Methods of Opiate Withdrawal
    • Opiate Agonist Agents to Treat Opioid Use Disorders
    • Medications for Prevention of Return to Use of Opioids
  • Pharmacological Treatment of the Tobacco Use Disorders
    • Nicotine Replacement Systems
    • Non-Nicotine Replacement Pharmaceuticals for Smoking Cessation
    • Experimental Compounds for Smoking Cessation
  • Chapter Summary
• Chapter 34. Return to Use and Other Problems Frequently Encountered in Substance Treatment
  • Common Problems
    • Limit Testing by Clients
    • The Clinician and Treatment “Secrets”
    • A Double Standard
    • Treatment Noncompliance
  • Willpower
  • Switching Addictions
  • Return to Use
  • Pain
    • Acute Injury
    • Chronic Pain
  • Controlled Drinking
  • Early Recovery and Sexual Activity
  • “Cravings” and “Urges”
  • The “Using” Dream
  • Toxicology Testing
    • Urine
    • Hair Sample Testing
    • Saliva
    • Sweat
    • Blood
  • Funding
    • Mental Health Parity Laws
  • Chapter Summary
  • Note
• Chapter 35. Support Groups to Promote and Sustain Recovery
  • The History of Alcoholics Anonymous
  • Elements of AA
    • A Breakdown of the 12 Steps
  • The Relationship Between Alcoholics Anonymous and Religion
  • One “A” Is for Anonymous
  • Alcoholics Anonymous and Outside Organizations
  • The Primary Purpose of Alcoholics Anonymous
  • Outcome Studies: The Effectiveness of Alcoholics Anonymous
  • Narcotics Anonymous
  • Other 12-Step Groups
    • Al-Anon
    • Alateen
  • Support Groups Other Than 12-Step Groups
    • Self-Management and Recovery Training (SMART)
    • Secular Organizations for Sobriety (SOS)
    • Women for Sobriety (WFS)
    • Moderation ManagementTM (MM)
    • LifeRing
    • Faith-Based Recovery Initiatives
    • Minority Group-Oriented Recovery Programs
  • Challenges to the Traditional 12-Step Movement
  • Chapter Summary
• Chapter 36. Substance Use Disorders and Infectious Disease
  • Why Is Infectious Disease Such a Common Complication for People with an SUD?
    • Sterile Technique
    • Contamination
  • Assorted Bacterial Infections Seen in Individuals Using Intravenous Drugs
    • Infective Endocarditis
    • Skin Abscesses
    • Necrotizing Fasciitis
  • The Pneumonias
    • Fungal Pneumonia
    • Aspiration Pneumonia
    • Community-Acquired Pneumonia (CAP)
  • Tuberculosis
    • What Is Tuberculosis?
    • How Is Tuberculosis Transmitted, and How Does It Kill?
    • The Treatment of TB
  • The Viral Infections
  • Acquired Immune Deficiency Syndrome (AIDS)
    • A Short History of AIDS
    • What Is AIDS?
    • Where Did HIV Come From?
    • The Scope of HIV Infection
    • Pediatric AIDS
    • How Does AIDS Kill?
    • The Chain of HIV Infection
    • Life Expectancy for People with HIV-1 Infection
    • The Treatment of HIV Infection
    • AIDS and Neurocognitive Dysfunction
    • Section Summary
  • COVID-19
  • Viral Hepatitis
    • A Brief History of Viral Hepatitis
    • Hepatitis A Virus
    • Hepatitis “B” Virus
    • Hepatitis “C” Virus
    • Hepatitis D
    • Hepatitis E
  • Chapter Summary
• Chapter 37. The Debate over Drugs
  • Harry Anslinger
    • The Lessons of History
    • The World of Today
  • The Substance Use Disorders: Symptom or Disease?
  • Criminal Activity and Drug Misuse: Partners in a Dance, but Who Is Leading?
    • Criminal Activity and Personal Responsibility
    • Manufactured Criminals
  • Drug Use and Violence: The Unseen Connection
    • Partner-Associated Violence
  • Adulterants
  • “Designer” Drugs
  • Some Existing Drug Analogs
    • Amphetamine-Like Designer Drugs
    • Khat
    • Mephedrone
    • MDPV (3,4-Methylenedioxypyrovalerone)
    • THC-Like Designer Drugs
    • Hallucinogenic Designer Drugs
    • Phenethylamines
    • Tryptamines
  • Designer Opioids
    • Fentanyl
    • Dextromethorphan (DXM)
    • Hydromorphone
    • Desomorphine
    • Kratom
    • Salvia (Salvinorin A and Salvia Divinorum)
  • Atypical Compounds of Misuse
    • Atypical Antipsychotic Compounds
    • Benzylpiperazine (BZP)
    • Medication Diversion
  • An Emerging Danger
  • Chapter Summary
• Chapter 38. The Debate Over Legalization
  • Statement of the Problem
  • The “War” on Drugs: an Ongoing National Disaster
    • The War on Drugs: the Fantasy
    • 1. Elimination of Raw Materials
    • 2. Interdiction
    • 3. Criminalization
    • 4. Treatment
  • The Reality of the War on Drugs
    • The Drug War as Political Nonsense
    • The War on Drugs as a Drain on National Resources
    • Other Consequences of the Prohibition Against Drug Use
    • Section Summary
    • The Law and Morality: Where to Draw the Line?
  • The Debate over “Medical Marijuana”
    • Cannabidiol (CBD) and Other Compounds in Cannabis
  • Legalization of Cannabis
  • Chapter Summary
• Appendix 1. The Diagnostic and Statistical Manual of Mental Disorders (5th Edition, Text Revision) (DSM-5-TR) and Substance Use Disorders
• Appendix 2. Drug Classification Schedules
• Appendix 3. The Twelve Steps of Alcoholics Anonymous
• Appendix 4. The “Jellinek” Chart for Alcoholism
• References

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