Concepts of Chemical Dependency, 10th ed.
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CONCEPTS of
CHEMICAL DEPENDENCY
10th edit ion
HAROLD E. DOWEIKO
Gundersen-Lutheran Medical Cente
La Crosse, WI
With contributions from
AMELIA L. EVANS
Liberty University
Australia ● Brazil ● Mexico ● Singapore ● United Kingdom ● United States
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Printed in the United States of America
Print Number: 01 Print Year: 2018
Concepts of Chemical Dependency,
Tenth Edition
Harold E. Doweiko
Product Director: Marta Lee-Pe
iard
Product Manager: Julie Martinez
Content Developer: Nicky Montalvo
Product Assistant: Allison Balchunas
Marketing Manager: Zina Craft
Art Director: Vernon Boes
Production Management and Composition:
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Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN XXXXXXXXXX
In loving memory of Harold Doweiko.
For Jan.
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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iv
Brief Contents
1 Why Wo
y About Substance Misuse
or Substance Use Disorders? 1
2 The Nature of the Beast 9
3 A Brief Introduction to the Science
of Pharmacology 17
4 An Introduction to Alcohol: Man’s
Oldest Recreational Chemical 30
5 The Alcohol Use Disorders 46
6 Misuse of Ba
iturates and Ba
iturate-
Like Compounds 63
7 Misuse of the Benzodiazepines
and Similar Agents 72
8 Use and Misuse of Central Nervous
System Stimulants 87
9 Cocaine Misuse and Cocaine Use Disorder 106
10 Marijuana Use and Misuse 119
11 Opioid Use and Misuse 134
12 Hallucinogen Misuse 159
13 Misuse of Inhalants and Aerosols 177
14 The Under-Recognized Problem
of Steroid Misuse 185
15 Tobacco Products and Tobacco Use 195
16 Over-the-Counter Analgesics 211
17 Chemicals and the Neonate 223
18 Gender and Substance Use Disorders 238
19 Hidden Faces of Substance Use Disorders 251
20 Substance Misuse by Children
and Adolescents 260
21 Substance Use and Substance Use
Disorders in College Students 288
22 Substance Use Disorders and
the Older Adult 298
23 Substance Use Disorders and the Family 304
24 Codependency and Enabling 313
25 The Client with Co-Occu
ing Disorders 323
26 The Biopsychosocial Model of
the Addictions 343
27 The Substance Use Disorders as a
Disease of the Human Spirit 376
28 The Assessment of Suspected
Substance Use Disorders 389
29 Intervention 405
30 Treatment Settings 415
31 The Treatment of Substance Use Disorders 424
32 The Process of Treatment 437
33 Pharmacological Interventions for
Substance Use Disorders 448
34 Relapse and Other Problems Frequently
Encountered in Substance Rehabilitation 470
35 Support Groups to Promote and
Sustain Recovery 493
36 Substance Use Disorders and
Infectious Disease 507
37 The Debate over Drugs 522
38 The Debate over Legalization 543
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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v
Preface xiii
CHAPTER 1
Why Wo
y About Substance Misuse
or Substance Use Disorders? 1
SUDs as Unsuspected Influences on Society 2
The Scope of the Problem of the SUDs 3
The Cost of Chemical Misuse and SUDs 6
Who Treats Persons with an SUD? 7
Designer Drugs for Pleasure: A
(Frightening) Brave New World 8
Chapter Summary 8
CHAPTER 2
The Nature of the Beast 9
Why Do People Choose to Use
Drugs or Alcohol? 10
Drug Use/Misuse Cycles 12
The Continuum of Chemical Use 12
What Do We Mean When We Say That
Somebody Is “Addicted” to a Chemical? 13
Definitions of Terms Used in This Text 14
Behavioral/Process “Addictions” 15
Unanswered Questions 15
Chapter Summary 16
CHAPTER 3
A Brief Introduction to the
Science of Pharmacology 17
A Basic Misconception 17
The Prime Effect and Side Effect of Chemicals 18
The Method by Which a Compound
Is Administered 18
Bioavailability 20
The Effective Dose 25
The Lethal Dose and Therapeutic Index 25
Therapeutic Threshold and Peak Effects 26
The Site of Action 26
The Receptor Site 26
The Process of Neurotransmission 27
The Blood-Brain Ba
ier 29
Chapter Summary 29
CHAPTER 4
An Introduction to Alcohol: Man’s
Oldest Recreational Chemical 30
Why Do People Consume Alcohol? 31
A Brief History of Alcohol 31
Alcohol Today 33
How Alcoholic Beverages Are
Produced Today 33
A Working Definition of Social Drinking 33
Scope of Alcohol Use in the World Today 34
The Pharmacology of Ethyl Alcohol 35
The Biotransformation of Alcohol 36
The Blood Alcohol Level (BAL) 37
Subjective Effects of Alcohol on the Individual
Who Drinks Socially at Normal Doses 38
Medical Complications of Alcohol Use for
the Individual Who Drinks Socially 39
Alcohol Use and the Diagnostic and Statistical
Manual of Mental Disorders (5th Edition) 45
Chapter Summary 45
Contents
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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vi CONTENTS
CHAPTER 5
The Alcohol Use Disorders 46
A Working Definition of the Alcohol
Use Disorders 47
Scope of the Problem 47
Who Is the Typical Person with an
Alcohol Use Disorder? 48
Physical Dependence, Tolerance, and
“Craving” 49
Complications of Chronic Alcohol Use 50
The Alcohol Withdrawal Syndrome 60
Alcohol Use and the Diagnostic and Statistical
Manual of Mental Disorders (5th Edition) 62
Chapter Summary 62
CHAPTER 6
Misuse of Ba
iturates and
Ba
iturate-Like Compounds 63
Early Medical Treatment of Anxiety
and Insomnia 63
History and Cu
ent Medical Uses
of Ba
iturates 64
Pharmacology of the Ba
iturates 65
Subjective Effects of Ba
iturates at
Normal Dosage Levels 67
Complications of Ba
iturate Use at
Normal Dosage Levels 67
Effects of the Ba
iturates at Above-
Normal Dosage Levels 68
Neuroadaptation, Tolerance, and Physical
Dependence on Ba
iturates 69
The Ba
iturate-Like Drugs 69
Alcohol Use and the Diagnostic and Statistical
Manual of Mental Disorders (5th Edition) 70
Chapter Summary 70
CHAPTER 7
Misuse of the Benzodiazepines
and Similar Agents 72
Scope of Prescribed Benzodiazepine Use 73
Medical Uses of the Benzodiazepines 73
The Pharmacology of the Benzodiazepines 73
Subjective Effects of Benzodiazepines
at Normal Dosage Levels 75
Side Effects of the Benzodiazepines When
Used at Normal Dosage Levels 76
Neuroadaptation to, Misuse of, and
Addiction to the Benzodiazepines 77
Drug Interactions Involving Benzodiazepines 80
Long-Term Consequences of Chronic
Benzodiazepine Use 80
The Benzodiazepine Receptor Antagonists
(Z-Compounds or BRAs) 81
Rohypnol 85
Sedative, Hypnotic, or Anxiolytic Use Disorders
and the Diagnostic and Statistical Manual
of Mental Disorders, 5th Edition 86
Chapter Summary 86
CHAPTER 8
Use and Misuse of Central
Nervous System Stimulants 87
I. CNS Stimulants as Used in Medical
Practice 88
II. CNS Stimulant Misuse 95
CNS Stimulant Misuse and the Diagnostic
and Statistical Manual of Mental
Disorders, 5th Edition 104
Chapter Summary 105
CHAPTER 9
Cocaine Misuse and Cocaine
Use Disorder 106
A Brief History of Cocaine 107
Cu
ent Medical Uses of Cocaine 108
Scope of the Problem of the Cocaine
Use Disorders 108
Pharmacology of Cocaine 109
How Illicit Cocaine Is Produced 111
Methods of Cocaine Misuse 111
Subjective Effects of Misused Cocaine 113
Complications of Cocaine Misuse and
Cocaine Use Disorder 113
CNS Stimulant Misuse and the Diagnostic
and Statistical Manual of Mental
Disorders, 5th Edition 118
Chapter Summary 118
CHAPTER 10
Marijuana Use and Misuse 119
A History of Marijuana Use/Misuse 120
Anecdotal Claims of Efficacy 120
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the