Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

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1. The Neurobiology of Substance Dependence 7symptoms seem of more limited importance. Treatment of the patient’s withdrawalsymptoms is based on understanding how withdrawal is related to thebrain’s adjustment to these drugs after chronic repeated high doses.Repeated exposure to escalating dosages of most drugs alters the brain, sothat it functions more or less normally when the drugs are present and abnormallywhen they are not. Two clinically important results of this alteration aredrug tolerance (the need to take higher and higher dosages of drugs to achievethe same effect) and drug dependence (susceptibility to withdrawal symptoms).Withdrawal symptoms occur only in patients who have developed tolerance.Tolerance occurs because the brain cells that have receptors or transporterson them gradually become less responsive to the stimulation by the exogenoussubstances. For example, more opioid is needed to inhibit the cyclic AMPsystem in the N-Ac neurons, as well as to stimulate the VTA brain cells of themesolimbic reward system to release the same amount of DA in the N-Ac.Therefore, more opioid is needed to produce pleasure comparable to that providedin previous drug-taking episodes. The mechanism for this reduction inresponse is related to the cyclic AMP coupling for opioids, but direct reductionsin the number of receptors or increases in the number of transporters can occur.For example, it appears that after chronic cocaine inhibition of the DA transporter,the number of DA receptors decreases, while the number of transportersmay increase to compensate for this chronic overstimulation of the N-Ac DAreceptors and chronic inhibition of the transporter (Kosten, 2002). Thesechanges associated with tolerance might be considered an attempt by the brainto attain relative homeostasis in the face of the disruption induced by theseabused drugs. Tolerance to alcohol may be due to a more complex series of neurobiologicalchanges at the neuronal and molecular levels, and involve GABA,opioid, DA, and other neurochemical systems, including the excitatory aminoacid neurotransmitters such as glutamate and its multiplicity of receptorsubtypes (Fadda & Rossetti, 1998). Tolerance to cannabinoids probably has asimilar mechanism to opioids, since the cannabinoid CB 1receptor is also a G-protein-coupled, cyclic AMP type receptor (Kosten, 2000; Stahl, 1998). Toleranceto hallucinogens such as lysergic acid (LSD) probably involves changes inthe serotonergic 5HT 2receptors, which involve the phosphoinositol phosphate(PIP) second messenger system, but this system’s relationship to chronic LSDuse has not been as extensively studied as the cyclic AMP system for the opioidsand cannabinoids (Kosten, 2000).Opioids provide an outstanding example to illustrate how the neurobiologicalchanges associated with tolerance are related to dependence and withdrawalsymptoms. Opioid dependence and some of the most distressing opioidwithdrawal symptoms stem from changes in the locus coeruleus (LC), anotherimportant brain system at the base of the brain (Figure 1.2). Neurons in the LCproduce noradrenaline (NA) and widely distribute it to other parts of the brainincluding the cerebral cortex, brainstem, and various subcortical regions, where
8FIGURE 1.2. Neuronal coupling of receptor to G protein and adenyl cyclase (converting enzyme) at baseline (Panel A), changes during acute opiateeffects (Panel B), changes after chronic opiate use (Panel C), and changes during acute opiate withdrawal (Panel D). After “resetting” of opiate receptorswith naltrexone, the number of receptors appears to increase to match the increased converting enzyme activity (see text).
Page 2: CLINICAL TEXTBOOK OF ADDICTIVE DISO
Page 5 and 6: © 2005 The Guilford PressA Divisio
Page 7 and 8: viAbout the EditorsMedical College.
Page 9 and 10: viiiContributorsStephen L. Dilts, M
Page 11 and 12: xContributorsRussell K. Portenoy, M
Page 13 and 14: xiiPrefaceof alcohol in the 2002 su
Page 15 and 16: xivPrefaceResearch (1) on health sy
Page 18 and 19: ContentsPART I. FOUNDATIONS OF ADDI
Page 20: ContentsxixPART V. TREATMENTS FOR A
Page 24 and 25: CHAPTER 1The Neurobiologyof Substan
Page 26 and 27: 1. The Neurobiology of Substance De
Page 38 and 39: 2. Historical and Social Context 17
Page 55 and 56: 34 I. FOUNDATIONS OF ADDICTIONThomp
Page 58 and 59: CHAPTER 3Psychological Evaluationof
Page 60 and 61: 3. Psychological Evaluation 39sever
Page 62 and 63: 3. Psychological Evaluation 41neuro
Page 64 and 65: 3. Psychological Evaluation 43In su
Page 66 and 67: 3. Psychological Evaluation 45subst
Page 68 and 69: 3. Psychological Evaluation 47is im
Page 70 and 71: 3. Psychological Evaluation 49Self-
Page 72 and 73: 3. Psychological Evaluation 51decis
Page 74 and 75: 3. Psychological Evaluation 53Socia
Page 76 and 77: 3. Psychological Evaluation 55Behav
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3. Psychological Evaluation 57socia
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3. Psychological Evaluation 59Lezak
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3. Psychological Evaluation 61Tarte
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CHAPTER 4Laboratory Testingfor Subs
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4. Laboratory Testing 65stance. It
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4. Laboratory Testing 67tive in lab
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4. Laboratory Testing 69Agency (USA
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4. Laboratory Testing 71CONCLUSIOND
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CHAPTER 5AlcoholEDGAR P. NACEAlcoho
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5. Alcohol 77withdrawal symptoms, b
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5. Alcohol 79Drug Abuse-DependenceA
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5. Alcohol 81symptoms as schizophre
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5. Alcohol 83show low incidences of
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5. Alcohol 85the rate of eliminatio
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5. Alcohol 87nisms. The symptoms of
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5. Alcohol 89individual with a hist
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5. Alcohol 91The small intestine sh
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5. Alcohol 93alcohol’s effect of
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5. Alcohol 95Bone marrow recovery w
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5. Alcohol 97Female breast cancer s
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5. Alcohol 99tion and management. P
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5. Alcohol 101nervosa and alcohol u
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5. Alcohol 103for alcohol-related p
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CHAPTER 6TobaccoNORMAN HYMOWITZHIST
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6. Tobacco 107geon General’s Advi
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6. Tobacco 109Smokers are wrong abo
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6. Tobacco 111significant substance
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6. Tobacco 113exacerbate existing i
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6. Tobacco 115Substance use, in gen
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6. Tobacco 117cological aids (Fager
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6. Tobacco 119ciently nonirritating
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6. Tobacco 121particular reinforcin
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6. Tobacco 123The results of a smal
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6. Tobacco 125proaches to smoking c
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6. Tobacco 127smoking, and to smoke
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6. Tobacco 129.02) and the 300-mg g
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6. Tobacco 131cholinergic bronchodi
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6. Tobacco 133Green, D.E. (1980). B
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6. Tobacco 135Orleans, C. T. (1993)
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6. Tobacco 137Monograph No. 17, DHE
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7. Opioids 139DEFINITIONSThe opioid
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7. Opioids 141sion of control chara
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TABLE 7.2. Opioid Withdrawal7. Opio
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7. Opioids 145The concept of tolera
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7. Opioids 147der with water, heat
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7. Opioids 149overdose in a pregnan
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7. Opioids 151who may inject from f
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7. Opioids 153more methadone, possi
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7. Opioids 155Bickel, W. K., Stitze
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Marijuana, Hallucinogens,and Club D
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8. Marijuana, Hallucinogens, and Cl
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9. Cocaine and Stimulants 185among
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9. Cocaine and Stimulants 187Cocain
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9. Cocaine and Stimulants 189ited,
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9. Cocaine and Stimulants 191postsy
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9. Cocaine and Stimulants 193herita
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9. Cocaine and Stimulants 195Kleber
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9. Cocaine and Stimulants 197When c
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9. Cocaine and Stimulants 199OBSTET
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9. Cocaine and Stimulants 201guide
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9. Cocaine and Stimulants 203Cognit
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9. Cocaine and Stimulants 205tity i
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9. Cocaine and Stimulants 207purifi
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9. Cocaine and Stimulants 209ence n
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9. Cocaine and Stimulants 211Brady,
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9. Cocaine and Stimulants 213others
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9. Cocaine and Stimulants 215Martin
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9. Cocaine and Stimulants 217DHHS P
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Sedatives/Hypnoticsand Benzodiazepi
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10. Sedatives/Hypnotics and Benzodi
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TABLE 10.1. Pharmacological Charact
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PART IVSPECIAL POPULATIONS
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246 IV. SPECIAL POPULATIONSThis con
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248 IV. SPECIAL POPULATIONSin patie
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250 IV. SPECIAL POPULATIONSdisorder
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252 IV. SPECIAL POPULATIONSsample o
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254 IV. SPECIAL POPULATIONSAntisoci
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256 IV. SPECIAL POPULATIONS(Cloning
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258 IV. SPECIAL POPULATIONSdrug is
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260 IV. SPECIAL POPULATIONSneous us
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262 IV. SPECIAL POPULATIONSamine an
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264 IV. SPECIAL POPULATIONSor bupre
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266 IV. SPECIAL POPULATIONSsonality
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268 IV. SPECIAL POPULATIONS(2001).
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270 IV. SPECIAL POPULATIONSTómasso
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272 IV. SPECIAL POPULATIONSAddition
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274 IV. SPECIAL POPULATIONStreatmen
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276 IV. SPECIAL POPULATIONSOther Th
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278 IV. SPECIAL POPULATIONSDIAGNOSI
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280 IV. SPECIAL POPULATIONStransfer
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282 IV. SPECIAL POPULATIONSSpecific
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284 IV. SPECIAL POPULATIONSattendin
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286 IV. SPECIAL POPULATIONSPHARMACO
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288 IV. SPECIAL POPULATIONSdiagnose
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290 IV. SPECIAL POPULATIONSimproved
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292 IV. SPECIAL POPULATIONSwith nov
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294 IV. SPECIAL POPULATIONSand abus
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296 IV. SPECIAL POPULATIONSpatients
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298 IV. SPECIAL POPULATIONSMahler,
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300 IV. SPECIAL POPULATIONSPowell,
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302 IV. SPECIAL POPULATIONSWeiss, R
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304 IV. SPECIAL POPULATIONSCORE FEA
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306 IV. SPECIAL POPULATIONSThe asso
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308 IV. SPECIAL POPULATIONSefficacy
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TABLE 13.2. Double-Blind, Placebo-C
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312 IV. SPECIAL POPULATIONSreceivin
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314 IV. SPECIAL POPULATIONSLike ind
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316 IV. SPECIAL POPULATIONSmomentar
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318 IV. SPECIAL POPULATIONSChambers
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320 IV. SPECIAL POPULATIONSorders.
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322 IV. SPECIAL POPULATIONSican wom
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324 IV. SPECIAL POPULATIONSamounts
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326 IV. SPECIAL POPULATIONSLiteratu
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328 IV. SPECIAL POPULATIONStrol and
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330 IV. SPECIAL POPULATIONS& Fein,
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332 IV. SPECIAL POPULATIONSAsian pr
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334 IV. SPECIAL POPULATIONSBaker, F
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336 IV. SPECIAL POPULATIONSGraves,
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338 IV. SPECIAL POPULATIONSDifferen
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CHAPTER 15Addictions in the Workpla
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342 IV. SPECIAL POPULATIONSOrganiza
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344 IV. SPECIAL POPULATIONSStimulan
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346 IV. SPECIAL POPULATIONSemployer
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348 IV. SPECIAL POPULATIONSshould b
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350 IV. SPECIAL POPULATIONSstances,
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352 IV. SPECIAL POPULATIONSbe halte
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CHAPTER 16Addiction and the LawAVRA
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356 IV. SPECIAL POPULATIONSobjected
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358 IV. SPECIAL POPULATIONSOver tim
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360 IV. SPECIAL POPULATIONSDisabili
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362 IV. SPECIAL POPULATIONSdrawal f
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364 IV. SPECIAL POPULATIONSStates h
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366 IV. SPECIAL POPULATIONSMcClella
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368 IV. SPECIAL POPULATIONSThe expa
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370 IV. SPECIAL POPULATIONSThere co
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372 IV. SPECIAL POPULATIONSTABLE 17
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374 IV. SPECIAL POPULATIONScommon m
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376 IV. SPECIAL POPULATIONSstand th
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378 IV. SPECIAL POPULATIONSapproach
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380 IV. SPECIAL POPULATIONS1. What
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TABLE 17.5. Opioid AsnalgesicsEquia
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384 IV. SPECIAL POPULATIONSadminist
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386 IV. SPECIAL POPULATIONSas methy
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392 IV. SPECIAL POPULATIONSArner, S
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394 IV. SPECIAL POPULATIONSPassik,
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CHAPTER 18Alcoholism and Substance
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398 IV. SPECIAL POPULATIONSdrug eff
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400 IV. SPECIAL POPULATIONSI (Zimbe
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402 IV. SPECIAL POPULATIONSAlcohol-
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404 IV. SPECIAL POPULATIONSStaffing
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406 IV. SPECIAL POPULATIONSLocation
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408 IV. SPECIAL POPULATIONSREFERENC
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410 IV. SPECIAL POPULATIONSSurock,
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412 IV. SPECIAL POPULATIONSfueling
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414 IV. SPECIAL POPULATIONSLipton &
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416 IV. SPECIAL POPULATIONSCo-abuse
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418 IV. SPECIAL POPULATIONSsion. We
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420 IV. SPECIAL POPULATIONSand the
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422 IV. SPECIAL POPULATIONSthe immu
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424 IV. SPECIAL POPULATIONSothers w
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426 IV. SPECIAL POPULATIONSfuture p
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428 IV. SPECIAL POPULATIONSand sex-
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430 IV. SPECIAL POPULATIONSCole, S.
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432 IV. SPECIAL POPULATIONSto reten
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434 IV. SPECIAL POPULATIONSSheridan
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436 IV. SPECIAL POPULATIONSDrug use
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438 IV. SPECIAL POPULATIONSthe trea
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440 IV. SPECIAL POPULATIONSweight),
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442 IV. SPECIAL POPULATIONSin misca
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444 IV. SPECIAL POPULATIONSdiagnose
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446 IV. SPECIAL POPULATIONSCLINICAL
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450 IV. SPECIAL POPULATIONSREFERENC
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452 IV. SPECIAL POPULATIONSand phys
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PART VTREATMENTS FOR ADDICTIONS
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458 V. TREATMENTS FOR ADDICTIONSAlt
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460 V. TREATMENTS FOR ADDICTIONSPSY
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462 V. TREATMENTS FOR ADDICTIONSkno
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464 V. TREATMENTS FOR ADDICTIONSThr
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466 V. TREATMENTS FOR ADDICTIONStor
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468 V. TREATMENTS FOR ADDICTIONSarr
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470 V. TREATMENTS FOR ADDICTIONScon
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472 V. TREATMENTS FOR ADDICTIONSKha
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CHAPTER 22Cognitive TherapyJUDITH S
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476 V. TREATMENTS FOR ADDICTIONSFIG
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480 V. TREATMENTS FOR ADDICTIONSand
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482 V. TREATMENTS FOR ADDICTIONSbet
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486 V. TREATMENTS FOR ADDICTIONSAdv
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488 V. TREATMENTS FOR ADDICTIONSThr
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490 V. TREATMENTS FOR ADDICTIONSthe
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492 V. TREATMENTS FOR ADDICTIONSIf
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494 V. TREATMENTS FOR ADDICTIONSThe
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496 V. TREATMENTS FOR ADDICTIONSMot
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498 V. TREATMENTS FOR ADDICTIONSRes
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500 V. TREATMENTS FOR ADDICTIONSLie
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CHAPTER 23Group Therapy, Self-Help
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504 V. TREATMENTS FOR ADDICTIONSTAB
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506 V. TREATMENTS FOR ADDICTIONSmai
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510 V. TREATMENTS FOR ADDICTIONSdri
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514 V. TREATMENTS FOR ADDICTIONSavo
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516 V. TREATMENTS FOR ADDICTIONSSel
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518 V. TREATMENTS FOR ADDICTIONSera
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520 V. TREATMENTS FOR ADDICTIONSins
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522 V. TREATMENTS FOR ADDICTIONSthi
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524 V. TREATMENTS FOR ADDICTIONSREF
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526 V. TREATMENTS FOR ADDICTIONSfor
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CHAPTER 24Family-Based TreatmentSta
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530 V. TREATMENTS FOR ADDICTIONS1.
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532 V. TREATMENTS FOR ADDICTIONSin
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534 V. TREATMENTS FOR ADDICTIONStre
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538 V. TREATMENTS FOR ADDICTIONSfir
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540 V. TREATMENTS FOR ADDICTIONSles
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542 V. TREATMENTS FOR ADDICTIONSove
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544 V. TREATMENTS FOR ADDICTIONS1.
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548 V. TREATMENTS FOR ADDICTIONSvs.
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550 V. TREATMENTS FOR ADDICTIONSWit
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554 V. TREATMENTS FOR ADDICTIONSBeh
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556 V. TREATMENTS FOR ADDICTIONSO
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558 V. TREATMENTS FOR ADDICTIONSadd
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560 V. TREATMENTS FOR ADDICTIONSinh
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562 V. TREATMENTS FOR ADDICTIONSabu
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564 V. TREATMENTS FOR ADDICTIONSPar
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566 V. TREATMENTS FOR ADDICTIONSeti
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570 V. TREATMENTS FOR ADDICTIONSpro
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572 V. TREATMENTS FOR ADDICTIONStie
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574 V. TREATMENTS FOR ADDICTIONSmos
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576 V. TREATMENTS FOR ADDICTIONSiss
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578 V. TREATMENTS FOR ADDICTIONStiv
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580 V. TREATMENTS FOR ADDICTIONSris
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582 V. TREATMENTS FOR ADDICTIONSHen
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584 V. TREATMENTS FOR ADDICTIONSLew
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586 V. TREATMENTS FOR ADDICTIONSRob
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CHAPTER 26Psychopharmacological Tre
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590 V. TREATMENTS FOR ADDICTIONSmen
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592 V. TREATMENTS FOR ADDICTIONS(1,
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594 V. TREATMENTS FOR ADDICTIONSred
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596 V. TREATMENTS FOR ADDICTIONShav
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598 V. TREATMENTS FOR ADDICTIONSKha
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600 V. TREATMENTS FOR ADDICTIONSSuc
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602 V. TREATMENTS FOR ADDICTIONSuse
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606 V. TREATMENTS FOR ADDICTIONScal
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608 V. TREATMENTS FOR ADDICTIONSwit
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610 V. TREATMENTS FOR ADDICTIONSon
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612 V. TREATMENTS FOR ADDICTIONSMas
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614 V. TREATMENTS FOR ADDICTIONSado
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616 V. TREATMENTS FOR ADDICTIONSule
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618 V. TREATMENTS FOR ADDICTIONSdia
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622 V. TREATMENTS FOR ADDICTIONSmen
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624 V. TREATMENTS FOR ADDICTIONSsta
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626 V. TREATMENTS FOR ADDICTIONShab
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628 V. TREATMENTS FOR ADDICTIONSadd
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630 V. TREATMENTS FOR ADDICTIONScog
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634 V. TREATMENTS FOR ADDICTIONScat
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636 V. TREATMENTS FOR ADDICTIONSLin
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638 V. TREATMENTS FOR ADDICTIONSBri
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640 V. TREATMENTS FOR ADDICTIONSpat
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642 V. TREATMENTS FOR ADDICTIONSalt
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644 V. TREATMENTS FOR ADDICTIONSere
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646 V. TREATMENTS FOR ADDICTIONS(Vo
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648 V. TREATMENTS FOR ADDICTIONSres
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650 V. TREATMENTS FOR ADDICTIONSfor
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652 V. TREATMENTS FOR ADDICTIONSVou
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654 V. TREATMENTS FOR ADDICTIONSto
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656 V. TREATMENTS FOR ADDICTIONSals
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658 V. TREATMENTS FOR ADDICTIONSGal
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660 V. TREATMENTS FOR ADDICTIONSMoy
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662 V. TREATMENTS FOR ADDICTIONStie
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664 IndexAfrican Americansadolescen
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666 IndexAsian Americans (cont.)rel
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668 IndexCocaine use and abuse (con
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670 IndexDepressionin adolescents,
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672 IndexFetal alcohol syndrome, 97
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674 IndexImpulse control disorders
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676 IndexMethamphetamine (cont.)neu
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678 IndexPPain managementadjuvant a
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680 IndexPsychological assessment (
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682 IndexSexual behaviorHIV infecti
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684 IndexWWernicke-Korsakoff syndro
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Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

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