Alcoholism, Drug Addiction, and the Road to Recovery

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1 Alcoholism, Drug Addiction, and the Road to Recovery Life on the Edge Barry Stimmel, MD The Haworth Medical Press An Imprint of The Haworth Press, Inc. New York London Oxford

2 CONTENTS Preface Acknowledgments xiii xvii PART I: BASIC CONCEPTS Chapter 1. Who Uses Drugs? 3 Drugs and the Young 4 Adults and Drug Use 5 Ethnicity and Drug Use 6 Drugs and the Workplace 6 Drug Use Among the Affluent 7 Summary 8 Chapter 2. Classifying Mood-Altering Drugs 9 Type of Classification 9 Differences and Similarities Among Drug Groups 11 Designer Drugs 17 Club Drugs 18 Performance-Enhancing Drugs 19 Summary 19 Chapter 3. Habituation, Dependency, and Addiction 21 Defining Terms 21 Effects of Drugs on the Brain 26 Chapter 4. Why People Use Drugs 35 Initiating Drug Use 35 Biological Determinants 36 Psychological Factors 38 Environment and Conditioning 40 Conclusion 40

3 Chapter 5. Identifying Inappropriate Drug Use and Drug Dependency 43 Signs and Symptoms of Drug Use 43 Addressing Drug Abuse in Your Children 46 Laboratory Aids to Identify Alcohol and Drug Use 48 The Value of Identifying Drug Users 57 Chapter 6. Treating Drug Dependency 59 Available Treatment Modalities 59 Evaluation of Treatment 70 After Treatment 74 The Law and Drug Treatment 74 PART II: MOOD-ALTERING DRUGS Chapter 7. Alcohol 85 Patterns of Use 86 Costs of Drinking 87 Common Alcoholic Beverages 88 How Alcohol Is Handled by the Body 90 Effects of Environment 95 Interaction with Other Drugs 96 Dependency and Withdrawal 97 Adverse Effects 98 Diagnosis 102 Reasons for Excessive Drinking 105 Alcoholism: A Disease or a Psychological Disorder? 108 Summary 116 Chapter 8. Central Nervous System Depressants and Antianxiety Agents 121 Patterns of Use 122 Barbiturates 123 Nonbarbiturate Hypnotics and Sedatives 125 Other Central Nervous System Depressants 127 Benzodiazepines 129 Miscellaneous Antianxiety Agents 133

4 Chapter 9. Powerful Hallucinogens, Phencyclidine, and Ecstasy 135 Classification 136 Adverse Effects of Hallucinogens 140 Ecstasy 141 Phencyclidine 143 Ketamine 146 Chapter 10. Marijuana 147 Reefer Madness 148 Patterns of Use 149 Tolerance, Dependency, and Withdrawal 152 Adverse Effects 153 Moving to Stronger Drugs 156 Medical Uses of Marijuana 156 Conclusion 157 Chapter 11. Opiates and Opioids 159 Opium Preparations 160 Action of Opioids on the Brain 161 Effects of Opioids on the Body 162 Tolerance, Dependency, and Withdrawal Opioids Susceptible to Nonmedical Use Opiate Agonists-Antagonists 169 Partial Opioid Receptor Agonists 171 Chapter 12. Heroin Addiction 173 Heroin from Opium: The Street Trade 173 Getting High and Coming Down 176 Prevalence 177 Adverse Effects 178 The Challenge of Treating Heroin Addiction 183 Measuring Treatment Effectiveness 201

5 Chapter 13. Amphetamines, Amphetamine-like Drugs, and Caffeine 203 Amphetamines 203 Amphetamine-Like Drugs 211 Caffeine 216 Chapter 14. Cocaine 221 Patterns of Use 222 Cocaine Metabolism 227 Dependency, Tolerance, and Addiction 228 Adverse Effects of Cocaine 229 Treatment of Cocaine Dependency 236 Chapter 15. Nicotine 243 Cigarette Smokers Today 245 Available Nicotine Products 246 Ingredients in Tobacco 250 Dependency, Tolerance, Addiction, and Withdrawal 254 Adverse Effects of Smoking 256 Treatment 261 Chapter 16. Volatile Solvents, Anesthetics, and Organic Nitrites 267 Volatile Solvents 267 Anesthetic Agents 272 Organic Nitrites 274 PART III: AREAS OF SPECIAL CONCERN Chapter 17. Multiple Drug Use 279 Alcohol and Other Drugs 281 Smoking and Drug Use 283 Opioids 284 Cocaine 284 Marijuana 284 Treatment 285

6 Chapter 18. AIDS and Drug Use 287 HIV: The Human Immunodeficiency Virus 287 Preventing HIV Transmission 294 Treatment of AIDS 297 Relationship Between the Use of Noninjecting Mood- Altering Drugs and HIV Infection 297 Summary 299 Chapter 19. Drugs, Pregnancy, and the Newborn 301 Incidence of Drug Use During Pregnancy 301 General Effects of Drugs on Pregnancy Outcome 302 Human Immunodeficiency Virus 312 Treatment of Drug Use and Dependency During Pregnancy 313 Prevention of Drug Use During Pregnancy 314 Chapter 20. Drugs and Sports 317 Stimulants 317 Anabolic S teroids 318 Growth Hormone 325 Erythropoietin 326 Detecting and Preventing Inappropriate Drug Use by Athletes 327 Appendix A: Drug Use Reporting Sources 329 Appendix B: List of Common Names for Drugs 331 Selected Bibliography 349 Index 395

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