Index

A Addiction medicine specialists Abstinence stage, 226, 227 addiction psychiatry, 12 Abstinence syndrome, 36, 62, 67, 68, 92, 93, 145, ASAM, 12 158, 159 Adolescence, 300–302 alcohol withdrawal, 50 accidents, 293 amphetamines, 101 aftercare plan, 303, 304 anabolic steroids, 183 alcoholic hepatitis, 298 barbiturates assessment, 295 detoxification, 62 behavioral signs and symptoms, 295, 296 symptoms, 62 court order, 298 bath salts, 109 definition, 291 benzodiazepines denial, 294 detoxification, 68 discharge planning, 303 high dose, short half-life, short duration of use, 67 drugs, 293, 294 long half-life, long duration of use, 67 drugs usage, 293, 296 low dose, long duration of use, 67 extended care, 303 rebound phenomenon, 67 family history, 297 symptom reemergence, 67 homicide, 293 caffeine, 111 inpatient treatment, 299, 302 cocaine, 107 medical assessment, 299 detoxification outpatient treatment, 303 buprenorphine (subutex), 92, 93 peer affiliation and acceptance, 292, 304 clonidine, 93 physical examination, 297 methadone, 93 physical growth and sexual maturation, 292 flunitrazepam (Rohypnol), 70 prefrontal cortex, 291 GHB, 72 prevalence, 292, 293 indications, 51, 52 psychological assessment, 300 methylphenidate (ritalin), 108 psychosocial assessment, 296, 297 opioid withdrawal, 92 rehabilitation process outpatient treatment, 50, 51 coping skills and relaxation therapy, 301 outpatient vs. inpatient detoxification, education, 300 52–53 group therapy, 300 phentermine, 109 individual therapy, 300 physical and physiologic changes, 9 life story, 301 rapid detoxification, 93–94 peer assessment, 301 severity, 9 recreational therapy, 301 stage 1, 49 spirituality, 301 stage 2, 49 support group attendance, 301 stage 3, 49 residential treatment, 303 symptoms, 92 screening questionnaire, 296 treatment, 50–53 sexually transmitted diseases, 298 Z drugs, 71 social assessment, 300 Acamprosate (campral), 237, 315 substance dependence, 294 Acute convulsions, 60 substance users, 298

© Springer International Publishing AG 2018 341 H.T. Milhorn, Substance Use Disorders, DOI 10.1007/978-3-319-63040-3 342 Index

Adolescence (cont.) neurological system, 47 teenage, 291 nose, 47 tough love and intervention, confrontation, 298 nutritional system, 47, 48 treatment recovery, 53 codependency, 302 reproductive system, 47 family therapy, 302 throat, 47 family week, 302 tolerance, 49 plan development, 300 treatment, 42 support group attendance, 302 type I alcoholism, 46 typical activity schedule, 302 type II alcoholism, 46 urine drug screen, 298 young adult subtype, 46 Adult children of alcoholics (ACOAs), 228, 267 young antisocial subtype, 46 consequences, 267 Alcoholic beverages, 41–42 dysfunctional characteristics, 267, 268 Alcoholic dementia, 310 laundry list, 268, 269 Alcoholic family, rules, 258 support groups, 269 Alcoholics Anonymous (AA), 10, 299 Aerosols, 157, 159, 160 history, 232 adolescent males, 156 meetings, 234, 235 clinical presentation, 159 philosophy, 232 hazardous chemicals, 157, 158 slogans, 233 health risks, 157, 158 12 steps, 232, 233 overdose 12 traditions, 234 azotemia, 160 Alcoholism cardiopulmonary monitoring, 160 direct alcohol biomarkers, 198 chest radiography, 160 indirect alcohol biomarkers, 198–201 chronic gasoline sniffing, 160 physical examination, 195–197 ECG, 160 self-administered questionnaires, hyaline casts, 160 191–193 serum chemistry, 160 Alcohol Use Disorders Identification Test (AUDIT), symptoms, 159 191–193 toluene, 160 Aldehyde dehydrogenase (ALDH), 44 treatment, 160 Alkyl nitrites pharmacology, 156, 157 amyl nitrite, 162 symptoms, 157 butyl nitrite, 162 Affinity, 31 cyclohexyl nitrite, 162 African Americans, 319, 320 health risks, 163 Aftercare, 288–289 overdose, 163–164 follow-up care, 221 pharmacology, 162, 163 Alcohol, 277, 278 street names, 162 Alcohol dehydrogenase (ADH), 44 Alpha-PVP. See Alpha-pyrrolidinovalerophenone Alcohol dependence, 236–237 (alpha-PVP) alcohol-related deaths, 42 Alpha-pyrrolidinovalerophenone alcohol-related liver problems, 42 (alpha-PVP), 110 cancer, 48 Alternative drugs cardiovascular complications, 47 clenbuterol, 184 chronic severe subtype, 46 creatine, 184 dermatological system, 48 EPO, 184 drinking, 42 GHB, 184 drinking and heavy drinking, 42 hCG, 184 ears, 47 HGH, 184 endocrine system, 47 insulin, 184 evaluation, 48, 49 insulin-like growth factor, 184 eyes, 47 vitamins and amino acids, 184 functional subtype, 46 American Indians/Alaska Natives, 318 gastrointestinal manifestations, 47 American Medical Association (AMA), 22, 335, 336 head, 47 American Medical Association’s Council on Mental health benefits, 48 Health, 331, 339 intermediate familial subtype, 46 American Society of Addiction Medicine (ASAM) metabolic disturbances, 47 criteria, 12, 22, 215 musculoskeletal effects, 47 American’s hidden problem, 310 Index 343

Amobarbital (Amytal), Schedule III drugs, 60 B Amotivational syndrome, 136 Bagging, 156 Amphetamine-related hallucinogens, 167, 171–173 Barbiturate-like drugs Amphetamines, 101, 102 ethchlorvynol (placidyl), 73 abstinence syndrome, 101 ethinamate (valmid), 73 acidifying agents, 99 glutethimide (doriden), 73 DEA Schedule II drugs, 98 methaqualone (quaalude), 73 dependence, 101 methyprylon (noludar), 74 market drugs, 98 Barbiturates methamphetamine, 99, 100 abstinence syndrome, 62 overdose abused street names, 60 symptoms, 101 acute convulsions, 60 treatment, 101–102 central nervous system depressants, 59 pharmacodynamics, 98 cluster and migraine headache treatment, 60 pharmacokinetics, 98, 99 CNS depressant drugs, 61 physically and psychologically addictive, 97 defined, 62 prevalence of use, 98 dispositional tolerance, 62 short-term and long-term health effects, 101 enhanced urinary elimination, 63 street names, 98 gastrointestinal decontamination, 63 sympathomimetic preparations, 99 general anesthesia induction, 60 tolerance, 101 health risks, 61–62 Anabolic steroids, 180, 181, 183 hepatic microenzymes, 61 abstinence syndrome, 183 intracranial pressure reduction, 60 adverse consequences, both sexes, lethal injection, 60 182, 183 medical and psychiatric treatment, 59 adverse effects, males and females, 182 overdose, 62, 63 alternative drugs (see Alternative drugs) pharmacodynamics, 61 anabolic-androgenic steroids, 179 pharmacokinetics, 61 denial, 183 pill form, 60 on drug screens, 183, 184 preanesthetic agent, 60 effects, 181, 182 prevalence of use, 59 healthy males, 179 sedation, 60 illegal use seizures treatment, 61 cycling, 181 sleep induction (hypnosis), 61 pyramiding, 181 supportive care, 63 stacking, 181 types of, 60 legal use Bath salts bone marrow problems, 180 abstinence syndrome, 109 chronic wasting conditions, 181 brand names, 109 delayed puberty in male, 180 cheap substitutes, 109 gender dysphoria, 180 DEA Schedule I substances, 109 growth stimulation, 180 health risks, 109 testosterone deficiency, 181 synthetic stimulants, 109 long-term, 183 tolerance and dependence, 109 pharmacology, 182 Behavioral treatment, 213 prevalence of use, 179, 180 Beneficial effect, 48, 56 receptors downregulation, 182 Benzodiazepines, 313, 315 smuggling, 179 abstinence syndrome, 67, 68 street names, 182 central nervous system depression, 65 tablet and injectable forms, 180 class of psychoactive drugs, 64 Antidiarrheal medications cognitive impairment, 66 diphenoxylate HCl/atropine (lomotil), 86 DEA Schedule IV drugs, 64 loperamide (imodium), 86 flunitrazepam (Rohypnol), 6 ASAM. See American Society of Addiction Medicine long-term, health risks, 66 (ASAM) criteria oral contraceptives, antifungal agents and Asian/Pacific Islanders, 318, 319 antibiotics, 66 Asphyxiation, 158 overdose, 68, 69 Atropine, 173 pharmacodynamics, 64 AUDIT. See Alcohol Use Disorders Identification Test pharmacokinetics, 64–65 (AUDIT) physiologic and psychological dependence, 66 344 Index

Benzodiazepines (cont.) Cigarettes street names, 64 benefits, quitting smoking, 118, 119 symptoms of depression, 66 combination pharmacotherapy, 127 tolerance, 66 drugs, 118 treatment use, 64 factors, 118 types, 64, 65 health risks, 118 Biomarkers nicotine, 116 direct alcohol, 198 pharmacodynamics, 117 indirect alcohol, 198–201 pharmacokinetics, 117, 118 Biopsychosocial definition, 19 relapse, 127 biological factors, 17–18 smokers, 116–117 psychological view, 18 smoking, 116 sociological factors treatment, 128 family problems, 19 weight gain, 127 financial problems, 19 Civil commitments, 211 isolation, 19 Clenbuterol, 184 legal problems, 19 Clonidine, 93, 126 Blood alcohol concentrations (BACs), 44 Club drugs, 5 Blood alcohol level (BAL), 43, 44, 48 CMRO. See Certified Medical Review Officer (CMRO) Blood-brain barrier (BBB), 33 CNS stimulants, 97–109 Breast and lung cancer deaths, women, 120 alpha-PVP, 110 Breastfeeding, 288 amphetamines (see Amphetamines) Buprenorphine, 238 (see also Bath salts) (see also Caffeine) buprenex, 87, 88 cocaine (see Cocaine) (see also Methylphenidate subutex, 92, 93 (ritalin)) Bupropion (Zyban), 126 modafinil (provigil), 109 Butane, 162 phentermine (see Phentermine) Butorphanol, 87 prevalence of use, 97, 98 Cocaine abstinence syndrome, 107 C antihypertensive properties, 106 Caffeine, 111, 311 chewing coca leaves, 105 abstinence syndrome, 111 coca leaves, 102–103 food and drink products, 110 coca paste, 103 intoxication, 110–111 cocaine HCl, 103 mood-altering drug, 110 coco paste smoking, 105 overdose crack/freebase, 106 symptoms, 111 DEA Schedule II drug, 102 treatment, 111 dependence, 107 powder, 110 Erythroxylum coca plant, 102 tolerance and dependence, 111 forms, 102, 103 CAGE-AID, 312 freebase, 104 CAGE questionnaire, 192 health risks, 106–107 Cannabinoid hyperemesis syndrome, 135 hydrochloride, 103 Cannabinoids, 131 intranasal HCl, 106 Cannabis intravenous, 106 male and female plant, 131 (see also Marijuana) oral intake, 105–106 medical marijuana, 132 overdose, 107 Cannabis indica, 131, 137, 140 pharmacodynamics, 104, 105 Cannabis ruderalis, 131 pharmacokinetics, 105 Cannabis sativa, 131 prevalence of use, 102 Cardiovascular system, 80 rock/crack cocaine, 103 Carisoprodol, 74 street names, 104 Centers for Disease Control and Prevention tolerance, 107 (CDC), 325 Coca leaves, 102–103 Certified Medical Review Officer (CMRO), 204 Coca paste, 103 Chewing tobacco, 121 Codeine (3-methylmorphine), 82 Chloral hydrate (Noctec), 74 Codependent, 254, 259, 264, 265 Chlordiazepoxide, 51 Cognitive behavioral therapy, 323 Chronic obstructive pulmonary disease (COPD), 118 Confidentiality in treatment, 221, 222 Index 345

Confrontation, 212 overdose Contingency management symptoms, 152 incentive-based interventions, 214 treatment, 152 MET, 214 pharmacology, 151 positive reinforcement, 214 street names, 151 prize incentives, 214 tolerance, dependence and abstinence syndrome, VBR, 214 151–152 Controlled drinking, 230 Dextrose in a Lactated Ringer’s Solution (D5LR), 148 Co-occurring disorders DHHS. See Department of Health and Human Services aftercare plan, 323 (DHHS) diagnosis, 322 Diagnosis, 279 dual diagnosis, 321 CAGE-AID, 280 primary psychiatric disorders, 321, 322 DAST-10, 280 secondary vs. primary psychiatric screening (see Screening questionnaires) disorders, 321 women addicts, 279 treatment, 322, 323 Diagnosis, substance use disorders, 191, 192, 198–201 Coping skills, 218 addicts, 204 Costs adulterated, diluted/substituted specimens, 204, 205 addicted vs. addict, 8, 9 alcoholics, 195 alcohol-related, 4 alcoholism, 195–197 deaths, 4 confirmatory techniques, 203 illicit drug-related, 4 denial mechanism, 190, 191 (see also Drug primary care physician, 5 screening) tobacco-related, 4 drug testing, 204 treatment, 4 false beliefs, 190 Court-ordered admission, 212 false-positive immunoassay tests, 204, 205 Crack/freebase cocaine, 106 federal workplace cutoff values, 203–205 CRAFFT questionnaire, 296, 304 hustlers, 194 Creatine, 184 inadequacy, 191 Cue extinction, 123 laboratory tests (see Laboratory tests) Cycling, 181 length of time, drug detection, 203 (see also Mixed drug dependencies) other drug dependencies, 192, 194, 196–200 D patient’s denial, 206 Dabbing, 138 patients behaviors, 194 DAST-10. See Drug Abuse Screening Test (DAST-10) personal and family history, 192–195 Date rape drugs, 6 screening questionnaires (see Screening questionnaires) Deaths, 4 undereducation, 190 Delta receptors, 78 2,5-Dimethoxy-4-iodophenethylamine (Smiles), 174 Denial mechanism, 190, 191 Diphenoxylate HCl/atropine (lomotil), 86 development, 7 Direct alcohol biomarkers, 198 drug use, 7 Discharge planning, 219, 303 illegal steroid dependence, 183 Disease concept tools, 8 adoption studies, 20 Department of Health and Human Services family studies, 20 (DHHS), 203 gene studies, 20 Designer drugs genetic markers, 20 adverse health effects, 89 genetic studies, 20 chronic pain, 90–91 primary care physician, 22 clandestine laboratories, 88 twin studies, 20 dependence, 90 Disulfiram, 236, 237 opioid groups, 88 D-lysergic acid diethylamide (LSD) prescribing, opioid dependence, 90 alkaloid lysergic acid, 168 risks and harms, 91–92 blotter microdot tablet, 168 selection, dosage, duration, follow-up and hydroxyethylamide, 169 discontinuation, 91 microdots, 168 street names, 89, 90 pharmacology, 168–169 tolerance, 90 potent hallucinogenic drugs, 168 Dextromethorphan (DXM), 152 prevalence of use, 168 health risks, 151 windowpanes, 168 346 Index

Doctor shopping, 11 physical aggression, 312 Dose-response plots, 30–31 physicians, 310, 311 Double Trouble in Recovery (DTR), 323 physiological changes, 308 Dronabinol (Marinol), 137 prescription addicts, 311 Drug Abuse Screening Test (DAST-10), 192, 194, 312 prevalence, 308 Drug courts, 211 rehabilitation, 313, 314 Drug Enforcement Administration (DEA), 239 SMAST-G, 312, 313 drug schedules, 13–14 surviving street addicts, 311 schedule II substances, 14–15 Electronic cigarettes (e-cigarettes) schedule III–V substances, 14 abstinence syndrome, 122 Drugs cartridges, 121 marijuana, 278 chewing tobacco, 121 MDMA, 278 cigars and pipes, 121 nicotine, 279 components, 120 opioids, 279 dependence, 122 sedative hypnotics, 279 liquid nicotine, 121 stimulants, 278 snuff, 121 Drug screening tolerance, 121–122 false-negative screens, 202 Elemicin, 173, 174 first-order kinetics, 202 Emergency department (ED), 4 immunoassays, 202 EMIT. See Enzyme multiplied immunoassay technique routine panels, 202 (EMIT) screening and confirmatory tests, 201 Endocrine system, 80 tampering prevention, 203 Enzyme multiplied immunoassay technique (EMIT), 202 thin-layer chromatography, 202 Erythropoietin (EPO), 184 urine sample, 201 Ethanol toxicity weak acids, 202 symptoms, 53 Drug-seeking behavior, 10 treatment, 53 DSM-5, 13 Ethchlorvynol (Placidyl), 73 Dusting, 156, 164 Ether, 162 Ethinamate (valmid), 73 Ethnic minority groups E categorization, 317, 318 Early drug treatment, 210 diagnosis, 320 Early institutional care, 209, 210 population, 317 Efficacy, 31 race, 317 Elderly recovery, 321 aftercare planning, 314, 315 treatment, 320 alcohol and drug abuse, 307, 309 Ethylene glycol toxicity arrhythmias, 312 diagnosis, 55 benzodiazepines, 311 symptoms, 55 binge drinker, 309 treatment, 56 cardiovascular system, 309 Excessive drinking, 45, 46 chlordiazepoxide (Librium) and diazepam (Valium), 311 chronic obstructive pulmonary disease, 310 F cocaine and methamphetamine, 308 Facsimile prescriptions, 14, 15 cognitive impairment, 310 False beliefs, 190 comorbid illnesses, 310 False-positive immunoassay tests, 204, 205 creatinine clearance, 308 Family, 256–261 dementia, 310 addicted adolescent, 261 detoxification, 313 addicted parent, 260, 261 drinking limits, 309 alcoholic, 258 drug-related health problems, 312 alcoholic spouse, 259 evaluation, 313 choices, 259 gastrointestinal disorders, 310 crime and violence, 254 hardy survivors, 309 denial, 257 late-onset group/reactors, 309 financial distress, 256 nicotine dependence, 311 grief, 257, 258 patients’ hospitalizations, 312 healthy, 254–256 Index 347

instability, 256 Flunitrazepam (Rohypnol) members, 256 abstinence syndrome, 70 cheating, 259 anxiety and sleep disorders, 69 conflict with partner, 259 DEA Schedule II drug, 70 emotional hardships, 259 dependence, 70 financial choices, 259 health risks, 70 jealousy and resentment, 259 oral administration, 69 patterns, 259 overdose, 70 separation, 259 pharmacology, 70 violence, 259 in sexual assaults (date rape), 69 mistrust, 256 street names, 70 principles, 254 tolerance, 70 problems of treatment, 211 Fluoxetine (Prozac), 135 routines, 254 Freebase cocaine, 104 shame and denial, 256 Freon, 162 single-parent families, 253 substance, 253 tough love, 262 G Family recovery Gamma-butyric acid (GABA), 43, 49, 56 early, 266 Gamma butyrolactone (GBL), 71 middle, 266 Gamma-hydroxybutyrate (GHB) acid, 6, 184 stages, 266, 267 abstinence syndrome, 72 Family therapy, 214 central nervous depressant, 71 Family treatment, 219 dependence, 72 addiction is a disease, 260 GBL, 71 children safe, 260 health risks, 72 child’s problem, 260 internet websites, 71 codependent treatment, 264–265 overdose, 72 importance, 264 pharmacodynamics, 72 normal as possible, 260 pharmacokinetics, 72 resources, 264 street names, 72 support groups, 265 tolerance, 72 therapy programs, 264 Ganja, 140 things will get better, 260 Gas chromatography/mass spectrometry (GC/MS), 203 Federation of State Physician Health Programs (FSPHP), Gastrointestinal decontamination, 63 336, 339 Gastrointestinal manifestations, 47 Fentanyl, 85 Gastrointestinal system, 80 Fetal alcohol syndrome (FAS), 284 GBL. See Gamma butyrolactone (GBL) Fetus GC/MS. See Gas chromatography/mass spectrometry alcohol effects, 284 (GC/MS) benzodiazepine, 285 Gender differences, 276 cocaine, 285 Gender dysphoria, 180 congenital defects, 284 Genetics of substance dependence, 20 inhalant effects, 286 Genitourinary system, 80 marijuana, 286 GHB. See Gamma-hydroxybutyric (GHB) acid nicotine, 285 Glutethimide (doriden), 73 opioid effects, 285 Grief process, 257, 258 phencyclidine effects, 286 Group therapy, 218, 323 phenobarbital abuse, 285 Growth stage, 227 stillbirth risks, 284 First-order reaction, 33–34 Five rules of recovery H ask for help, 229 Half-life, 33, 34 be completely honest, 229 Halfway houses, 220–221 categories, 229 Hallucinogen persisting perception disorder (HPPD), 175 change your life, 229 Hallucinogenic drugs, 169–171, 175, 176 self-care, 229 amphetamine-related, 167, 171–173 Five-panel drug test, 203 atropine and scopolamine, 173 Flakka. See Alpha-pyrrolidinovalerophenone 2,5-dimethoxy-4-iodophenethylamine (Smiles), 174 (alpha-PVP) ibogaine, 174 348 Index

Hallucinogenic drugs (cont.) Indirect alcohol biomarkers, 198–201 25I–NBOMe (N-bomb), 174 Individual therapy, 218 indolealkylamines, 167 (see Indolealkylamines) Indolealkylamines, 167 lysergamides, 167, 168 description, 170 MDEA, 173 mappine (bufotenine), 171, 172 MDMA (see 3,4-Methylenedioxymethamphetamine 5-MeO-DMT, 171, 172 (MDMA)) psilocybin and psilocin, 170, 171 muscimol and ibotenic acid, 168, 173 Inhalants, 155, 156 myristicin and elemicin, 173, 174 categorization overdose (see Overdose) aerosols, 155 phenylethylamines, 167 (see Phenylethylamines) gases, 156 prevalence of use, 168 nitrites, 156 Hashish/hash, 138 volatile solvents, 155 Hash oil, 138, 139 prevalence, 155, 156 Hawaiian baby woodrose seeds, 167 Inpatient treatment Head rush, 163 detoxification, 216 Health risks, 283 elements, 215 Healthy family, 254–256 health problems treatment, 216 Hematological abnormalities, 47 medical assessment, 215 Heroin (diacetylmorphine), 82, 83 psychological assessment, 217 High-pressure liquid chromatography, 203 social assessment, 217 Hispanic Americans, 320 state-run programs and private History, substance dependence treatment programs, 215 civil commitments, 211 Insomnia, 251 drug courts, 211 Insulin-like growth factor, 184 early drug treatment, 210 Integumentary system, 80 early institutional care, 209, 210 Intensive outpatient treatment, 220 modern alcoholism, 210 Intervention by confrontation pharmacotherapy, 211 alcoholic’s tearful acceptance, 263 HIV-positive patients, 326–328 preparing, 262, 263 community resources Intravenous cocaine, 106 family needs, 328 Isopropyl alcohol (isopropanol) patient needs, 327–328 diagnosis, 54 needles/paraphernalia, 325 symptoms, 54 psychosocial treatment treatment, 54 acceptance stage, 327 crisis stage, 326, 327 transitional stage, 327 K recovery, 327 Kappa receptors, 78 risk factors, 325, 326 Kaufman Adolescent and Adult Intelligence Test risk reduction, 327 (KAIT), 300 sexual contact, 325 Ketamine (Ketalar), 150 substance-dependent treatment, 326 DEA Schedule III controlled treatment goals, 326 substance, 149 HPPD. See Hallucinogen persisting perception disorder health effects (HPPD) long term, 150 Huffing, 156, 164 short term, 150 Human chorionic gonadotropin (hCG), 184 intoxication and overdose, 151 Human growth hormone (HGH), 184 pharmacodynamics, 150 Hungry, angry, lonely, or tired (HALT), 247 pharmacokinetics, 150 Hydrocodone, 84 prevalence, 149 Hydromorphone (dilaudid), 84 street names, 150 tolerance, dependence and abstinence syndrome, 150–151 I Ketamine bladder syndrome, 150 Ibogaine, 174 K-hole, 150, 152 Immune system, 80 Kindling, 31 Immunoassays, 202 Korsakoff’s psychosis, 310 Impaired woman physician, 334, 335 Krokodil, homemade drug, 84 Index 349

L Maternal detoxification Laboratory tests CNS depressants, 283 alcoholism, 198–201 opiods, 283, 284 chest X-rays and EKGs, 198 other drugs, 284 other drug dependencies, 201 Medical Association of Georgia’s Impaired Physician Legal problems of treatment, 211 Program, 338 Levo-alpha-acetylmethadol (LAAM), 239 Medical Marijuana, 137 LGBT patients Medical problems of treatment, 211–212 counselor training and education, 324 Medication therapy, 323 diagnosis, 325 Meperidine (demerol), 84 gender identity, 324 Meprobamate (Miltown, Equanil) homosexual/bisexual identity, 323 carisoprodol, 74 methamphetamine, 324 chloral hydrate (Noctec), 74 sexual orientation, 324 European Medicines Agency, 74 transgender people, 324 overdose, 74 treatment, 325 Mescaline, 169 verbal and physical attacks, 324 MET. See Motivational enhancement therapy (MET) LifeRing Secular Recovery (LSR), 213 Metabolism, 44, 45, 48, 53–55 Liver’s cytochrome P450 enzyme Methadone (dolophine), 85, 93, 238, 239 system, 135 Methamphetamine Locked-door syndrome, 333 narcolepsy and blood pressure, 99 Long-term monitoring, 126 pharmacology, 100 Long-term NRT, 126 prevalence of use, 99, 100 Loperamide (imodium), 86 street names, 99, 100 LSD. See D-lysergic acid diethylamide (LSD) synthetic drug, 99 LSR. See LifeRing Secular Recovery (LSR) Methaqualone (quaalude), 73 Lysergamides, 167, 168 Methyl alcohol (methanol) Lysergic acid diethylamide (LSD), 134, 298 diagnosis, 54 Lysergic acid hydroxyethylamide, 169 symptoms, 54 treatment, 54, 55 3,4-Methylenedioxymethamphetamine (MDMA) M prevalence of use, 172 Mappine (bufotenine), 171, 172 raves Marijuana, 139 in US, 172 abstinence syndrome, 139 serotonergic neurons, 172 accidents, 136 serotonin neurotransmission, 171 benzodiazepines, 135 sextasy/trail mix, 173 blood sugar levels, 135 side effects, 172 blunts, 132 sympathomimetic effects, 172 cancer, 136 Methylphenidate (ritalin) cardiovascular system, 135–136 abstinence syndrome, 108 dependence, 139 abuse and abusers, 107 drugs, 135 ADD, ADHD and narcolepsy treatment, 107 immune system, 135 health risks, 108 low blood pressure, 135 mild central nervous system stimulant, 107 overdose pharmacodynamics, 108 symptoms, 139 pharmacokinetics, 108 treatment, 139 pharming, 107 pharmacodynamics, 133 street names, 107 pharmacokinetics, 133, 134 tolerance and dependence, 108 prevalence, 132–133 Methyprylon (noludar), 74 psychiatric/behavioral, 136 Michigan Alcohol Screening Test (MAST), 191 reproductive system, 136 Microdots, 168 respiratory system, 136 Minnesota Multiphasic Personality Inventory-Adolescent street names, 133–135 (MMPI-A), 300 tolerance, 139 Mixed drug dependencies Mask anabolic steroids, 183, 184 CNS depressant drugs, 204 MAST. See Michigan Alcohol Screening Test hallucinogens, 205 (MAST) marijuana and alcohol, 205 350 Index

Mixed drug dependencies (cont.) N-methyl-D-aspartate (NMDA), 43, 144 stimulants and depressants, 205 Non-12-step programs, 212, 213 substance dependence, 205 Non-nicotine medications urine/serum drug screens, 204 bupropion, 126 Modafinil (Provigil), 109 varenicline, 126 Modern alcoholism treatment, 210 Nortriptyline, 127 Morning glory seeds, 167 Morphine, 82 Motivational enhancement therapy (MET), 214 O Mu receptors, 78 Obesity, 251 Muscimol and ibotenic acid, 173 Office-based opioid therapy (OBOT), 239 Muscle spasm, 252 Opiates, 77 Myristicin, 173, 174 Opioid agonist-antagonists buprenorphine (buprenex), 87, 88 butorphanol, 87 N description, 86 Nabilone (Cesamet), 137 nalbuphine, 87 Nabiximols (Sativex), 137 pentazocine (talwin), 86, 87 Nalbuphine, 87 Opioid agonists Naloxone (Narcan), 88 codeine (3-methylmorphine), 82 Naltrexone, 88, 237, 238 hydrocodone, 84 National Institute on Alcohol Abuse and Alcoholism hydromorphone (dilaudid), 84 (NIAAA), 309 krokodil, homemade drug, 84 Natural course of alcoholism morphine, 82 chronic phase, 22 naloxone (Narcan), 88 crucial phase, 21 natural opiates, 81 prealcoholic phase, 21 opium, 81, 82 prodromal phase, 21 oxycodone, 83 Natural opiates, 81 oxymorphone, 84 Neonatal abstinence syndromes thebaine, 81 opioids, 286 Opioid dependence, 237 other drugs, 287 Opioid drugs, 78–80 Neonatal detoxification clinical uses, 81 nonpharmacologic methods, 288 CNS depressants, 81 opioids, 287 dose equivalents, 81 other drugs, 288 generic and trade names, 78, 79 Neonatal opioid abstinence syndrome, 286, 287 narcotics, 77 Neurotransmitters, 29, 30 naturally occurring, semisynthetic, and synthetic, 77 Nicotiana tabacum, 115 (see also Opioid agonists) Nicotine gum (Nicorette), 125 pharmacodynamics, 78 Nicotine inhaler, 126 pharmacokinetics (see Pharmacokinetics) Nicotine lozenges, 125 prevalence of use, 77–78 Nicotine nasal spray, 125 Opioid overdose Nicotine replacement therapy (NRT) symptoms, 94 mechanisms, 125 treatment, 94 nicotine gum, 125 Opium, DEA schedule drug, 81, 82 nicotine inhaler, 126 Outpatient treatment nicotine lozenges, 125 components, 219 nicotine nasal spray, 125 description, 219 sublingual nicotine tablets, 125–126 intensive, 220 transdermal nicotine patches, 125 standard, 219 Nitrous oxide Overdose, 53–56, 62, 63, 68, 69, 72, 175, 176 butane, 162 barbiturates ether, 162 clinical manifestations, 63 Freon, 162 dose-dependent respiratory health risks, 161 depression, 62 overdose, 162 symptoms, 62–63 pharmacology, 161 benzodiazepines propane, 162 signs and symptoms, 68–69 street names, 161 treatment, 69 whippets, 160 flunitrazepam (Rohypnol), 70 Index 351

GHB peripheral effects, 80 symptoms, 72 subcutaneous and intramuscular treatment, 72 sites, 78 hallucinogens route of administration, 31–32 imaging studies, 176 steady-state relationships, 34–35 laboratory studies, 176 street names, 45 symptoms, 175 thermoregulatory system, 45 treatment, 176 urinary system, 45

Overprescribing physicians Vd, 32, 33 dated, 12 Z drugs, 71 disabled physicians, 12 zero-order kinetics, 43 dishonest, 12 Pharmacological approaches duped, 12 acamprosate (campral), 237 Oxycodone, 83 alcohol dependence, 236–237 Oxymorphone, 84 buprenorphine, 238 disulfiram, 236, 237 LAAM, 239 P methadone, 238, 239 Parents, 294 naltrexone, 237, 238 Partial recovery, 230 opioid dependence, 237 Peer assessment, 218 revia, 237 Pentazocine (talwin), 86, 87 suboxone, 238 Pentobarbital (Nembutal), Schedule III vivitrol, 237 drugs, 60 Pharmacology Pharmacodynamics, 43 flunitrazepam (Rohypnol), 70 amphetamines, 98 methamphetamine, 100 barbiturates, 61 Phencyclidine (PCP), 146–149 benzodiazepines, 64 abstinence syndrome, 145 biological response, 25 agitation, disorientation and hallucination, 143 cocaine, 104, 105 dependence, 145 GHB, 72 differential diagnosis, 149 kindling, 31 dosage, 145 methylphenidate (ritalin), 108 emergence phenomena, 149 neurotransmitters, 29, 30 health risks, 145 opioid drugs, 78 management receptors, 25, 26 rhabdomyolysis, 147 reward center, 28 stage I (intoxication), 147, 148 reward circuit, 29 stage II (overdose), 148 synaptic function, 27, 28 stage III (severe overdose), synaptic transmission, 26–27 148, 149 upregulation and downregulation, 29 pharmacodynamics, 144 Z drugs, 71 pharmacokinetics, 144, 145 Pharmacokinetics, 78–80 polydrug usage, 149 amphetamines, 98, 99 prevalence, 144 barbiturates, 61 stage I (intoxication) benzodiazepines, 64–65 behavioral manifestations, 146 circulatory system, 45 physical manifestations, 146 CNS, 44 stage II (overdose) cocaine, 105 behavioral manifestations, 146 distribution, 32 physical manifestations, 146 enzyme inhibition, 34 stage III (severe overdose) excessive drinking, 45–46 behavioral manifestations, 147 gastrointestinal system, 45 physical manifestations, 147 GHB, 72 street names, 144 interaction of alcohol, 45 tolerance, 145 metabolism, 44 Phentermine methylphenidate (ritalin), 108 abstinence syndrome, 109 opioid drugs DEA Schedule IV drug, 108 CNS effects, 80 side effects, 108 esters, 79 tolerance and dependence, 109 parenchymatous tissues, 79 weight reduction, 108 352 Index

Phenylethylamines, 167 Protracted withdrawal syndrome, 321 intense hallucinations, 170 Psilocybin and silocin, 170, 171 mescaline, psychogenic substance, 169 Psychoactive substances Salvia divinorum, 170 CNS, 5–7 Philosophy, 232 drugs, 5 Physical dependence, 36 Psychotherapy, 323 Physician health program (PHP), Pyramiding, 181 335, 339 Physicians, 338 aftercare, 338–339 Q characteristics, 333, 334 Quitting smoking, 123 community involvement, 332 behavioral techniques confrontation, 336, 337 contingency management, 123 employment patterns, 333 coping skills, 123 factors, 332 self-control strategies, 123 family life, 332, 333 stimulus control strategies, 123 female, 334, 335 patient, 123, 124 hospital duties, 333, 334 reasons, 122 identification, 331 stages, 122, 123 intervention team, 336 intravenous opioid/cocaine abusers, 332 office conduct, 333 R physical status, 333 Rapid detoxification, 93–94 prevalence, 332 Rapid eye movement (REM) sleep, 61 professional and nonprofessional intervention, 336 Rational use, 231–232 recovery, 339 Receptors, 25, 26 substance abuse, 331–332 Recovery, 232–235 treatment abstinence stage, 226, 227 halfway houses, 338 controlled drinking, 230 inpatient, 338 drugs, 230, 231 mirror imaging, 338 five rules, 229, 230 Post-acute withdrawal syndrome (PAWS), 227 growth stage, 227 Potency, 31 medications, 240 Pregnant addict partial, 230 health risks, 283 rational use, 231, 232 medical problems, 283 repair stage, 227 obstetrical concerns, 283 SAMSHA, 226 Prescription dependence six developmental periods, 228 doctor shopping, 11 slips/relapses, 226 drug-seeking behavior, 10 support groups (see Support groups) patient behaviors, 10–11 task, 226 Prescription drug abuse, 311 Recreational therapy, 218 Prevalence, 4 Rehabilitation Prevalence of use, 276 coping skills, 218 Preventing relapse, 249 discharge planning, 219 Primary care physician, 222 education, 217 gastrointestinal conditions, 251 family treatment, 219, 220 insomnia, 251 group therapy, 218 long-term management, 250 individual therapy, 218 muscle spasm, 252 peer assessment, 218 obesity, 251 recreational therapy, 218 pain management, 251 relaxation therapy, 218 recovering addicts, 250 spirituality, 219 stress reduction, 251 support group attendance, 219 upper respiratory problems, 251 Relapse Primary psychiatric disorders, 321, 322 definition, 243 Primary substance use disorder, 328 factors, 247 Primitive survival brain, 6 patient recovering, 251 Prize incentives contingency management, 214 prevention, 249 Propane, 162 stages, 244–246 Index 353

syndrome, 243 Sniffing/snorting, 156, 164 triggers, 248 Snuff, 121 Relaxation therapy, 218 Solvents. See Aerosols REM. See Rapid eye movement (REM) sleep SOS. See Secular Organizations for Sobriety (SOS) Repair stage, 227 Spice/K2, 137 Revia, 237 Sponsor, 234 Reward center, 27–29, 37 Stacking, 181 Robo-tripping/skittling, 151, 152 Stages of relapse Rock/crack cocaine, 103 emotional, 244 mental, 244 physical, 244 S ten phases, 244–247 Salvia divinorum Standard outpatient treatment, 219 herb in mint family, 170 Steroid abusers, 181 pharmacology, 170 Street names religious ceremonies, 170 abstinence syndrome, 175 Scames for hallucinogens, 175 dishonest way, 11 HPPD, 175 left-sided chest pain, 11 tolerance and dependence, 175 prescription fraud, 11 Sublingual nicotine tablets, 125–126 Scopolamine, 173 Suboxone, 238 Screening questionnaires Substance Abuse and Mental Health Services alcohol, 279 Administration (SAMHSA), 225 alcoholism, 191–193 Substance dependence treatment, 209–211 T-ACE questionnaire, 279 behavioral treatment, 213 TWEAK, 280 CBT, 213 Secobarbital (Seconal), DEA schedule drug, 60 contingency management, 214 Secondary vs. primary psychiatric disorders, 321 court-ordered admission, 212 Secondary substance use disorder, 328 family problems, 211 Secular Organizations for Sobriety (SOS), 213 family therapy, 214 Sedative-hypnotics agents, 59–71 history (see History, substance dependence treatment) barbiturate-like drugs, 73, 74 imbedded behaviors, 213 barbiturates (see Barbiturates) intervention, 212 benzodiazepines (see Benzodiazepines) legal problems, 211 (see also Flunitrazepam (Rohypnol)) medical problems, 211–212 (see also Support groups) defined, 59 tough love, 212 GHB (see Gamma-hydroxybutyric (GHB) acid) work problems, 212 (see also Meprobamate (Miltown, Equanil)) Substance use disorders, 189–191 (see also Z drugs) diagnosis (see Diagnosis, substance use disorders) Self-care, 229 primary care settings, 189 Self-Management for Addiction Recovery questionnaires, 189 (SMART), 213 Sudden sniffing death syndrome, 157 Self-medication theory, 321 Suffocation, 158 Semisynthetic opioids Supplemental Security Income (SSI), 327 description, 82 Support group attendance, 219 heroin (diacetylmorphine), 82, 83 Support groups, 221 Serotonin syndrome, 151 AA history, 232 Set and setting, 36, 37 active participation, 229 Short Michigan Alcohol Screening Test family treatment, 265 (SMAST), 191 meetings, 234, 235 Short-term health risks, 47 non-12-step programs, 212, 213 Short-term outpatient therapy, 338 philosophy, 232 Skunk, 137 slogans, 233 Sleep induction (hypnosis), 61 12 steps, 232, 233 SMART. See Self-Management for Addiction Recovery 12 traditions, 234 (SMART) twelve-step programs, 213 SMAST. See Short Michigan Alcohol Screening Test Synthetic cannabinoids (SMAST) hashish, 138 SMAST-G, 312, 313, 315 hash oil, 138, 139 Smoking intervention, 123, 124 Spice, 137, 138 354 Index

Synthetic opioids U description, 84 Undereducation, 190 fentanyl, 85 Upregulation and downregulation, 29 meperidine (demerol), 84 Urine/blood drug screening tests, 157 methadone (dolophine), 85 tramadol (ultram), 86 V Varenicline (Chantix), 126 T VBR. See Voucher-based reinforcement T-ACE questionnaire, 280 (VBR) Target syndrome, 332 Ventral tegmental area (VTA), 28, 29 Ten-panel drug test, 203 Vivitrol, 237

Tetrahydrocannabinol (THC), 131 Volume of distribution (Vd), 32 Therapeutic communities, 220 Voucher-based reinforcement (VBR), 214 Thin-layer chromatography, 202 Tobacco, 115 Tobacco plant, 116 W Tobacco usage, 124 Wax, 138 Tolerance Web-based recovery support, 235 cross-tolerance, 35, 36 Wernicke-Korsakoff syndrome, 310 dispositional, 35 WFS. See Women for Sobriety (WFS) pharmacodynamic, 35 Whippets, 160, 161, 164 Tough love, 262 Windowpanes, 168 Tramadol (ultram), 86 Withdrawal symptoms, 287, 288 Transdermal nicotine patches, 125 Women for Sobriety (WFS), 213 Treatment, 280–282 Work problems of treatment, 212 Treatment program options, 217–219 addictionist and counselors, 217 aftercare, follow-up care, 221 Z ASAM criteria, 215 Z drugs confidentiality, 221, 222 abstinence syndrome, 71 halfway houses, 220–221 DEA schedule IV drug, 70 inpatient treatment, 215–217 (see also Outpatient dependence, 71 treatment) detoxification, 71 primary care physicians, 222 health risks, 71 rehabilitation (see Rehabilitation) nonbenzodiazepine drugs, 70 support groups, 221 pharmacodynamics, 71 therapeutic communities, 220 pharmacokinetics, 71 Twelve-step programs, 10, 213 Zero-order reaction, 33