Addictive Disorders in Medical Populations E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1616

Veröffentlichungsjahr: 2011

Beschreibung

This book has a much wider focus than traditional books written about drug and alcohol addictions. This unique book is written by medical specialists who diagnose, treat and research addictive disorders in their specialities. Thus, it meets the needs of the typical medical practitioner who wants to learn about and treat patients with addictive disorders in their practices. Because alcohol and drug problems are so prevalent and affect medical conditions profoundly, the medical specialist will improve their knowledge and skill to diagnose and treat addictive disorders in their specialties. Drug and alcohol addictions occur commonly in medical populations; 25-50% of patients seen by primary care physicians have alcohol and drug disorders, with even higher prevalence in certain medical specialty populations. Drug use (including illicit drug use and actual or perceived misuse of prescribed medications), alcohol use, and what has been called unhealthy drinking are even more common in trauma centers and our society. Currently, there are no authoritative addiction texts that focus on the identification, intervention and management of either "addictive disorders in medical populations" or "medical complications in addiction populations". Neurobiological progress in the field of addiction has been amazing and evidence-based treatments have developed at a phenomenal pace, with bench to office applications for tobacco, alcohol and drugs. Pharmacological and psychosocial treatments are described here in detail and in practical terms. The medical and mental complications of addiction are explained comprehensively throughout the text. Clinical considerations are the predominant theme, with the standards of clinical practice grounded in the most current research. The chapters include practical presentations of both clinical and research materials, with instruments for screening and assessment and treatment. It will be useful for all those seeking information to help a patient or family with a tobacco, alcohol or drug problem. We hope this book can give answers and direction to the identification and management of addictions and their medical complications in patient populations.

Leseprobe

CONTENTS

List of Contributors

Preface

Acknowledgements

Part One: Addictive Disorders and Medicine

1 Addictive Disorders as an Integral Part of the Practice of Medicine

1.1 OVERVIEW

1.2 CLINICAL PREVALENCE

1.3 CLINICAL DIAGNOSIS

1.4 CLINICAL COMORBIDITY

1.5 TREATMENT OF MEDICAL DISORDERS ASSOCIATED WITH ALCOHOL AND DRUG USE AND ADDICTION

1.6 WHY PHYSICIANS ARE UNPREPARED TO TREAT DRUG- AND ALCOHOL-RELATED DISORDERS

1.7 SUMMARY

2 Crime, Substance Use, and Mental Illness

2.1 INTRODUCTION

2.2 EPIDEMIOLOGY

2.3 BASIC LEGAL AND FORENSIC CONCEPTS

2.4 FORENSIC ASSESSMENT

2.5 CLINICAL COURSE

2.6 CONCLUSIONS

3 Ethical Issues in Addiction Medicine

3.1 INTRODUCTION

3.2 THE DISCIPLINE OF ETHICS

3.3 ETHICAL ISSUES AND ADDICTION

3.4 SPIRITUALITY, RELIGION AND ADDICTION

4 Natural History of Addictive Diseases

4.1 INTRODUCTION

4.2 NATURAL HISTORY VERSUS “CAREER”

4.3 RISK AND PROTECTIVE FACTORS IN DEVELOPMENT OF ADDICTIVE DISEASE

4.4 INDIVIDUAL FACTORS

4.5 THE ROLE OF ENVIRONMENT IN ADDICTIVE DISEASE

4.6 THE ONSET OF ADDICTIVE DISEASE

4.7 THE PROGRESSION OF ADDICTIVE DISEASE

4.8 SUMMARY

5 Prevention Methods: School, Family, Community, Media and Public Policy Approaches

5.1 OVERVIEW

5.2 CLINICAL PREVALENCE

5.3 CLINICAL COMORBIDITY

5.4 CLINICAL COURSE OR ETIOLOGICAL PRECURSORS: RISK AND PROTECTIVE FACTORS

5.5 PREVENTION OF ALCOHOL AND DRUG USE AND ADDICTION AND ASSOCIATED MEDICAL DISORDERS

Part Two: Assessment and Diagnosis

6 Screening and Diagnosis of Substance Use Disorders

6.1 OVERVIEW

6.2 SCREENING

6.3 DIAGNOSTIC DETERMINATIONS

6.4 SUMMARY

7 Clinical Pharmacology of Addicting Drugs

7.1 OVERVIEW

7.2 BASIC CONCEPTS OF PK/PD

7.3 PK/PD FACTORS FOR DRUGS OF ADDICTION

7.4 PK/PD OF PRESCRIPTION DRUGS

7.5 PK/PD OF NICOTINE

7.6 PK/PD OF ALCOHOL

7.7 CONCLUSIONS

8 Laboratory Diagnosis of Addicting Drugs

8.1 INTRODUCTION

8.2 DRUG TESTING

8.3 METHODOLOGY FOR DRUG TESTING

8.4 SENSITIVITY AND SPECIFICITY

8.5 SCREENING VS. CONFIRMATION METHODS

8.6 SPECIMENS

8.7 ALCOHOL

9 Cutaneous Manifestations of Drug Addiction

9.1 INTRODUCTION

9.2 CLINICAL MANIFESTATIONS

9.3 CELLULITIS AND SOFT TISSUE INFECTIONS

9.4 FUNGAL INFECTION

9.5 VASCULAR LESIONS AND VASCULITIS

9.6 ACNE AND PILOSEBACEOUS EFFECTS

9.7 ASSOCIATED NONINFECTIOUS SKIN DISEASES

9.8 DRUG INDUCED REACTIONS

Part Three: Addictive Disorders and Clinical Diseases

10 Addictive Disorders in Primary Care Medicine

10.1 INTRODUCTION

10.2 MEDICAL AND PSYCHIATRIC COMPLICATIONS OF ADDICTION

10.3 TREATMENT-INDUCED REDUCTIONS IN MORTALITY AND MORBIDITY

10.4 ROLE OF PRIMARY CARE PHYSICIANS IN THE IDENTIFICATION AND TREATMENT OF ADDICTIONS

11 Addictive Disorders in the Intensive Care Unit

11.1 OVERVIEW

11.2 PREVALENCE OF ADDICTIVE DISORDERS IN THE CRITICALLY ILL

11.3 DIAGNOSING ADDICTIVE DISORDERS IN CRITICALLY ILL PATIENTS

11.4 CLINICAL DIAGNOSES, PATHOPHYSIOLOGY AND TREATMENT

11.5 INFLUENCE OF DRUG AND ALCOHOL ADDICTION ON THE MANAGEMENT OF CRITICALLY ILL PATIENTS

11.6 LONG-TERM PSYCHOSOCIAL EFFECTS OF CRITICAL ILLNESS AND THEIR ROLE IN ADDICTION

12 Addictive Disorders in Trauma Center Patients

12.1 OVERVIEW

12.2 ALCOHOL USE AND INJURY

12.3 CLINICAL COURSE AND PATHOPHYSIOLOGY

12.4 SCREENING AND INTERVENTION FOR ALCOHOL ADDICTION IN TRAUMA PATIENTS

12.5 CONCLUSIONS

13 Addictive Disorders in Psychiatric Medicine

13.1 INTRODUCTION

13.2 ALCOHOL AND DRUG-INDUCED PSYCHIATRIC COMPLICATIONS

13.3 COMORBID ADDICTIVE AND PSYCHIATRIC DISORDERS

13.4 INTERVENTION AND TREATMENT

13.5 ADDICTION TREATMENT FOR CO-OCCURING DISORDER PATIENTS

13.6 CONCLUSIONS

14 Addiction and Short-Term Pain Management

14.1 DEVELOPING A THERAPEUTIC APPROACH

14.2 GENERAL GUIDELINES

14.3 CONCLUSIONS

15 Prescription Opiate Medications: Clinical Assessment and Treatment of Tolerance and Dependence

15.1 EXTENT OF DEPENDENCE ON OPIATE MEDICATIONS

15.2 SIGNS AND SYMPTOMS OF DEPENDENCE ON OPIATE MEDICATIONS

15.3 PSYCHOLOGICAL CONSEQUENCES (CHEMICALLY INDUCED)

15.4 OCCUPATIONAL DIFFICULTIES AS A RESULT OF ADDICTION

15.5 BIOLOGICAL MECHANISMS UNDERLYING ADDICTION AND DEPENDENCE

15.6 PHYSIOLOGICAL RESPONSES TO INTOXICATION

15.7 TOLERANCE AND DEPENDENCE

15.8 INCREASED SENSITIVITY TO CHRONIC ADMINISTRATION OF OPIOID MEDICATIONS

15.9 SYMPTOMS OF PHARMACOLOGICAL DEPENDENCE AND WITHDRAWAL FROM OPIATES

15.10 TREATMENT OF WITHDRAWAL

15.11 CONTINUED TREATMENT OF ADDICTION

15.12 PREVENTION AND LONG-TERM INTERVENTIONS

16 Substance addiction and HIV infection: scope of the problem and management

16.1 INTRODUCTION

16.2 SCOPE OF THE PROBLEM

16.3 MATRIX OF HIV AND SUBSTANCE ADDICTION

16.4 SUBSTANCE ADDICTION AND HIV RISK IN OLDER ADULTS

16.5 BIOLOGY OF THE SUBSTANCE MISUSING HIV-INFECTED INDIVIDUAL

16.6 MANAGEMENT OF ADDICTION OR DEPENDENCY ON MEDICALLY INDICATED AGENTS

16.7 EXPERIENCE OF AN URBAN HIV CLINIC AND SUBSTANCE ADDICTS

16.8 CONCLUSIONS

17 Addictive disorders in cardiovascular medicine

17.1 INTRODUCTION

17.2 TOBACCO

17.3 ALCOHOL

17.4 COCAINE

17.5 AMPHETAMINES

17.6 PHENCYCLIDINE (PCP)

17.7 MARIJUANA

17.8 OPIATES

17.9 INFECTIVE ENDOCARDITIS

17.10 CONCLUSIONS

18 Alcohol use and diseases of the eye

18.1 INTRODUCTION

18.2 OCULAR PROBLEMS IN CHILDREN WITH FETAL ALCOHOL SYNDROME (FAS)

18.3 CATARACT

18.4 KERATITIS

18.5 OPTIC NEUROPATHY

18.6 COLOR VISION DEFICIENCIES

18.7 CORNEAL OPACITY

18.8 ACUTE VISUAL LOSS AND ALCOHOLIC PANCREATITIS

18.9 EFFECTS ON SENSORY PROCESSING

18.10 GLAUCOMA

18.11 OCULAR BENEFITS OF MODERATE ALCOHOL CONSUMPTION

18.12 CONCLUSIONS

19 Addictive disorders in nutritional diseases - from an addictions viewpoint

19.1 INTRODUCTION

19.2 ALCOHOL

19.3 OTHER DRUG ADDICTIONS

19.4 TREATMENT OF NUTRITIONAL DISEASES IN ADDICTED PATIENTS

19.5 CONCLUSIONS

20 Addictive disorders in nutritional diseases - from a nutritional viewpoint

20.1 INTRODUCTION

20.2 INTERACTION OF ADDICTIVE DISORDERS WITH DISEASE-SPECIFIC MEDICAL NUTRITION THERAPY

20.3 FUTURE DIRECTIONS

21 Gastrointestinal diseases associated with substance addiction

21.1 INTRODUCTION

21.2 ALCOHOL CONSUMPTION AND THE GASTROINTESTINAL SYSTEM

21.3 TOBACCO AND THE GASTROINTESTINAL SYSTEM

21.4 OPIATE USE AND THE GASTROINTESTINAL SYSTEM

21.5 INJECTING DRUG USE AND THE GASTROINTESTINAL SYSTEM

21.6 COCAINE AND THE GASTROINTESTINAL SYSTEM

21.7 ECSTASY (MDMA) AND THE GASTROINTESTINAL SYSTEM

22 Addictive disorders in malignant diseases

22.1 INTRODUCTION

22.2 ROLE OF ALCOHOL AND DRUGS IN MALIGNANCY

22.3 TREATMENT OF MALIGNANCY IN PATIENTS WITH ADDICTIVE DISORDERS

22.4 PAIN MANAGEMENT IN CANCER PATIENTS WITH PREVIOUS OR PRESENT ADDICTION

22.5 CONCLUSIONS

23 Substance addiction and gastrointestinal malignancy

23.1 INTRODUCTION

23.2 ROLE OF ADDICTION IN SPECIFIC GI MALIGNANCIES

23.3 PALLIATIVE CARE ISSUES

24 Renal manifestations of recreational drug use

24.1 INTRODUCTION

24.2 COCAINE

24.3 HEROIN

24.4 ECSTASY

24.5 INHALANTS

24.6 AMPHETAMINES

24.7 ETHANOL

24.8 HALLUCINOGENIC MUSHROOMS

24.9 BENZODIAZEPINES

24.10 TOBACCO AND MARIJUANA

24.11 CHRONIC NARCOTIC ADDICTION IN THE RENAL DISEASE PATIENT POPULATION

24.12 DRUG CLEARANCE IN CKD AND ESRD

24.13 CONCLUSIONS

25 Addictive disorder in urological diseases

25.1 INTRODUCTION

25.2 ALCOHOL ADDICTION

25.3 TOBACCO ADDICTION

25.4 ILLICIT DRUG ADDICTION

Part Four: Management of addictive disorders in selected populations

26 Management of addictive disorders in medical nursing care populations

26.1 INTRODUCTION

26.2 ROLE OF THE MEDICAL NURSE

26.3 COMPLICATIONS

26.4 CUES OF ADDICTION

26.5 EARLY INTERVENTIONS FOR PROBLEM USE OF ALCOHOL AND OTHER DRUGS

26.6 INTERVENTIONS FOR ADDICTIONS

27 Management of Addictive Disorders in Surgical Nursing Care Practice

27.1 INTRODUCTION

27.2 PREVALENCE OF ADDICTIVE DISEASE IN SURGICAL NURSING POPULATIONS

27.3 COMPLICATIONS FROM ADDICTIVE DISORDERS IN SURGICAL NURSING CARE

27.4 THE REDUCTION IN MORBIDITY AND MORTALITY FROM TREATMENT

27.5 THE ROLE OF THE SURGICAL NURSE IN DIAGNOSIS AND TREATMENT OF ADDICTIONS

27.6 APPROACH TO DIAGNOSIS OF ADDICTIONS

27.7 SCREENING INSTRUMENTS FOR ADDICTION

27.8 EARLY INTERVENTIONS FOR PROBLEM USE OF ALCOHOL AND DRUGS

27.9 INTERVENTIONS FOR ADDICTIVE DISORDERS

28 Addictive Disorders in Psychology Practice

28.1 OVERVIEW

28.2 CLINICAL PREVALENCE

28.3 CLINICAL DIAGNOSIS

28.4 CLINICAL COMORBIDITY

28.5 CLINICAL COURSE

28.6 PSYCHOLOGICAL TREATMENT OF ALCOHOL AND DRUG USE DISORDERS

28.7 CONCLUSIONS

29 Addictive Disorders in Diseases of Women

29.1 INTRODUCTION

29.2 PREVALENCE OF ADDICTIVE DISORDERS IN WOMEN

29.3 ROLE OF ALCOHOL AND DRUGS IN THE DISEASES OF WOMEN

29.4 MORBIDITY FROM ALCOHOL AND DRUGS, INCLUDING GENDER SPECIFICITY

29.5 MORTALITY FROM ALCOHOL AND DRUGS, INCLUDING GENDER SPECIFICITY

29.6 APPROACH TO THE DIAGNOSIS OF ADDICTION IN WOMEN

29.7 ASSESSMENT OF THE ROLE OF DRUGS AND ALCOHOL IN DISEASES OF WOMEN

29.8 TREATMENT OF DISEASES IN ADDICTED WOMEN

29.9 INTERVENTION AND REFERRAL FOR WOMEN WITH THE DISEASE OF ADDICTION

30 Children and Adolescents with ADHD: Risk and Protective Factors for Addictive Disorders

30.1 INTRODUCTION

30.2 BACKGROUND ON ADHD

30.3 ADHD AND ADDICTION

30.4 TREATING ADDICTION IN ADHD

30.5 CONCLUSIONS

31 Addictive Disorders in the Elderly

31.1 DEMOGRAPHICS OF AGING

31.2 OVERVIEW: IDENTIFYING ADDICTIVE DISORDERS IN THE ELDERLY

31.3 ROLE OF ADDICTIVE DISORDERS IN THE DISEASES OF THE ELDERLY

31.4 ROLE OF ADDICTIVE DISORDERS IN MEDICATION USE IN THE ELDERLY

31.5 ASSESSMENT OF ALCOHOL USE IN OLDER PATIENTS

31.6 INTERVENTION AND REFERRAL

31.7 CONCLUSIONS

Part Five Treatment of Addictive Disorders

32 Pharmacological Therapeutics for Detoxification in Addictive Disorders

32.1 INTRODUCTION

32.2 ALCOHOL

32.3 SEDATIVE-HYPNOTICS

32.4 NICOTINE

32.5 CANNABIS

32.6 COCAINE AND OTHER STIMULANTS

32.7 OPIATES

32.8 INHALANTS

32.9 HALLUCINOGENS

32.10 CONCLUSIONS

33 Pharmacological Therapeutics for Relapse Reduction in Addictive Disorders

33.1 SIGNIFICANCE TO THE CLINICIAN

33.2 CLINICAL PREVALENCE

33.3 CLINICAL RELEVANCE OF RELAPSE

33.4 CLINICAL DIAGNOSIS OF RELAPSE

33.5 PHARMACOLOGIC THERAPEUTIC INTERVENTIONS FOR RELAPSE PREVENTION AND TREATMENT

33.6 CONCLUSIONS

34 Psychosocial Treatments for Addictive Disorders: Models, Settings, and Important Roles for Referring Physicians

34.1 INTRODUCTION

34.2 THE COURSE OF ADDICTIVE DISORDERS

34.3 SCREENING AND INITIAL REFERRAL OF PATIENTS

34.4 DESCRIPTIONS OF PSYCHOSOCIAL TREATMENTS FOR SUD

34.5 SELF-HELP FOR SUBSTANCE USE DISORDER

34.6 ROLE OF REFERRING PHYSICIAN DURING SELF-HELP AND/OR PROFESSIONAL SUD TREATMENT

34.7 CONTINUING CARE

34.8 MANAGING TREATMENT-RESISTANT PATIENTS

34.9 CONCLUSIONS

35 Treatment Models for Comorbid Psychiatric and Addictive Disorders

35.1 INTRODUCTION

35.2 STRESS COPING AND SELF-MEDICATION MODELS

35.3 TREATMENT IN THE COMMUNITY

35.4 12-STEP APPROACHES

35.5 COGNITIVE AND BEHAVIORAL THERAPIES

35.6 CONCLUSIONS

36 Brief Interventions for Alcohol and Drug Problems

36.1 INTRODUCTION

36.2 BRIEF MOTIVATIONAL INTERVENTIONS

36.3 USE OF SCREENING AND ASSESSMENT IN INTERVENTION PROCESS

36.4 RESEARCH ON BRIEF INTERVENTIONS

36.5 SPECIAL POPULATIONS

36.6 SUMMARY OF BRIEF INTERVENTION TRIALS

36.7 SBIRT MODEL

36.8 RESEARCH TO PRACTICE: GOALS AND COMPONENTS OF BRIEF INTERVENTIONS FOR CLINICIANS

36.9 BRIEF THERAPIES FOR SUBSTANCE USE PROBLEMS

36.10 COGNITIVE-BEHAVIORAL THERAPIES: COPING SKILLS AND RELAPSE PREVENTION

36.11 RELAPSE PREVENTION STRATEGIES

36.12 ADDITIONAL BRIEF THERAPIES FOR ADDRESSING SUBSTANCE ADDICTION

36.13 CONCLUSIONS

37 Treatment Outcomes for Addictive Disorders

37.1 INTRODUCTION

37.2 DOES TREATMENT WORK?

37.3 WHAT ARE THE OUTCOMES OF TREATMENT?

37.4 GENERAL EFFECTIVENESS

37.5 SYSTEM-LEVEL FACTORS THAT INFLUENCE OUTCOMES

37.6 PHARMACOLOGICAL TREATMENT OUTCOMES

37.7 PSYCHOSOCIAL AND BEHAVIORAL TREATMENT OUTCOMES

37.8 OUTCOMES IN NON-SPECIALTY SETTINGS

37.9 OUTCOMES ASSOCIATED WITH MEDICAL TREATMENT

37.10 IS TREATMENT COST EFFECTIVE?

37.11 SPECIAL POPULATIONS

37.12 CONCLUSIONS

APPENDIX 37.A NIDA PRINCIPLES OF EFFECTIVE TREATMENT

38 Biopsychosocial Recovery from Addictive Disorders

38.1 OVERVIEW: SIGNIFICANCE TO THE CLINICIAN

38.2 PROTRACTED WITHDRAWAL SYNDROMES AND INITIAL RECOVERY

38.3 THE COMPLEXITY OF DEFINING RELAPSE

38.4 PHYSICIAN SUPPORT: ASSESSMENT, REFERRAL, AWARENESS AND FOLLOW-UP

38.5 CONCLUSIONS

Index

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Library of Congress Cataloguing-in-Publication Data

Addictive disorders in medical populations / editors, Norman S. Miller, Mark S. Gold.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-74033-0 (cloth)

1. Patients–Substance use. 2. Comorbidity. 3. Dual diagnosis. 4. Substance abuse. I. Miller, Norman S. II. Gold, Mark S.

[DNLM: 1. Substance-Related Disorders–diagnosis. 2. Substance-Related Disorders–therapy. WM 270 A225 2010]

RC564.A325 20100

362.29–dc22

2010010280

ISBN: 978-0-470-74033-0

List of Contributors

Herman S. Bagga, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Kristen L. Barry, University of Michigan Department of Psychiatry and Department of Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI 48109, USA

Kathleen L. Becker, John Hopkins University School of Nursing, Baltimore, MD, USA

W. Murray Bennett, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA

Kendra Gail Bergstrom, Division of Dermatology, University of Washington, Seattle, WA 98104, USA

Andrea Bial, Department of Medicine, Section of Geriatrics, University of Chicago Medical Center, Chicago, IL, USA

Frederic C. Blow, University of Michigan Department of Psychiatry and Department of Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI 48109, USA

Shannon K. Bolon, Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA

W. Kline Bolton, Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA

Carolina F. Braga, Department of Psychiatry, College of Medicine & McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA

Steven A. Branstetter, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802-6501, USA

Ashley R. Braun, University of Illinois, Chicago, IL, USA

Laurie Brockmann, University of Michigan Department of Psychiatry, Ann Arbor, MI 48109, USA

Garland A. Campbell, Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA

Kendall Campbell, Department of Community Health and Family Medicine, University of Florida, Gainesville, FL 32611, USA

Lucy Chen, MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

James A. Cocores, Department of Psychiatry, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL 32611, USA

Abdullah Demirkol, Drug Health Services, Sydney South West Area Health Service, Sydney, and University of Sydney, Australia

Hartmut Derendorf, Department of Pharmaceutics, University of Florida, Gainesville, FL 32611, USA

Daniel P. Evatt, University of Illinois, Chicago, IL, USA

John Finney, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA

Marc Fishman, Mountain Manor Treatment Center, Baltimore, MD 21229, USA, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA

Kimberly G. Blumenthal, Yale University School of Medicine, New Haven, CT 06510, USA

Mark S. Gold, College of Medicine, Chairman, Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Medicine, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL 32611, USA

Mark L. Gonzalgo, The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Alan H. Gradman, Division of Cardiovascular Diseases, The Western Pennsylvania Hospital, Temple University School of Medicine (Clinical Campus), Pittsburgh, Pennsylvania, USA

Noni A. Graham, Department of Psychiatry, College of Medicine and McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA

Larry Gray, University of Chicago, Pritzker School of Medicine, Department of Pediatrics, Section of Developmental Pediatrics, Comer Children's Hospital at the University of Chicago, Chicago, IL, USA

Deborah V. Gross, MD, Psychiatry and Addiction Medicine, Medical Director, Ridgeland, MS 39157, USA

K.P. Gunaga, Toxicology Testing Center, Sparrow Health System, St. Lawrence Campus, Lansing, MI 48915, USA, and Division of Human Pathology, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA

Satheesh Gunaga, Henry Ford Wyandotte Hospital, Department of Emergency Medicine and Medical Education, Wyandotte, MI 48192, USA

Thomas J. Guzzo, The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Paul S. Haber, Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia, and Addiction Medicine, University of Sydney, Sydney, Australia

Jason T. Hedrick, Department of Surgery, Division of Surgical Oncology, Wright State University, Dayton, OH, USA

Adrienne J. Heinz, University of Illinois, Chicago, IL, USA

Yoshimune Hiratsuka, Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan

Norman G. Hoffmann, Evince Clinical Assessments, Waynesville, NC, USA, and Western Carolina Uni- versity, Cullowhee, NC, USA

Robert C. Hyzy, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA

Nosheen Javed, Division of Cardiovascular Diseases, The Western Pennsylvania Hospital, Temple University School of Medicine (Clinical Campus), Pittsburgh, Pennsylvania, USA

Jon D. Kassel, University of Illinois, Chicago, IL, USA

Kenneth L. Kirsh, The Pain Treatment Center of the Bluegrass, Lexington, KY 40503

Stephen A. Klotz, Section of Infectious Diseases, University of Arizona, Tucson, Arizona, USA

Firas H. Kobeissy, Department of Psychiatry, College of Medicine & McKnight Brain Institute, University of Florida, Gainesville, FL 32611, USA, and Center for Neuroproteomics and Biomarkers Research

Karol L. Kumpfer, Department of Health Promotion and Education, University of Utah, Salt Lake City, Utah 84112, USA

Jessica B. Leitzsch, Division of Nutrition, Department of Bioscience and Biotechnology, Drexel University, Philadelphia, PA 19104, USA

Adam W. Levinson, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Jiang Liu, Department of Pharmaceutics, University of Florida, Gainesville, FL 32611, USA Roberta Springer Loewy, UC Davis, University of California, Sacramento, CA 95670, USA

Sabina Low, Department of Psychology, Wichita State University, Wichita, Kansas 67260, USA

Tracy R. Luckhardt, Division of Pulmonary, Allergy, and Critical Care, University of Alabama Birmingham, Birmingham, AL, USA

John McKellar, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA

Mary C. McCarthy, Division of Trauma/Surgical Critical Care/Emergency General Surgery, Wright State University-Boonshoft School of Medicine, Miami Valley Hospital, Dayton, OH 45409, USA

Robert Mallin, Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA

Jianren Mao, MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

Clifford Martin, Section of Infectious Diseases, University of Arizona, Tucson, Arizona, USA

Phyllis J. Mason, John Hopkins University School of Nursing, Baltimore, MD, USA

Charles Meredith, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA

Lisa J. Merlo, Department of Psychiatry, Division of Addiction Medicine, University of Florida, Gainesville, FL 32611, USA

Norman S. Miller, Clinical Professor, Department of Medicine, Michigan State University, East Lansing, Michigan 48824, USA, and Courtesy Professor, Department of Psychiatry, The University of Florida, Gainesville, FL 32611, USA

Rudolf Moos, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, CA 94025, USA

Michael E. Msall, Section of Developmental and Behavioral Pediatrics, University of Chicago, Pritzker School of Medicine, Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Institute of Molecular Pediatric Sciences, Section of Community Health, Ethics, and Policy, Comer Children's Hospital at the University of Chicago and LaRabida Children's Hospital, Chicago, IL, USA

Geetha Nampiaparampil, General Adult Psychiatry, St. Vincent's Hospital, New York Medical College, New York City, New York, USA

Jennifer A. Nasser, Division of Nutrition, Department of Bioscience and Biotechnology, Drexel University, Philadelphia, PA 19104, USA

Sara Jo Nixon, Division of Addiction Research, Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA

Milap A. Nowrangi, General Adult Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Morrow Omli, Department of Psychiatry, Division of Addiction Medicine, University of Florida, Gainesville, FL 32611, USA

James R. Ouellette, Department of Surgery, Division of Surgical Oncology, Wright State University, Dayton, OH, USA

Ellen A. Ovson, MD, Internal Medicine, Hattiesburg, MS 39402, USA

Jennifer J. Park, University of Chicago, Pritzker School of Medicine, Kennedy Research Center and Institute of Molecular Pediatric Sciences, Section of Developmental and Behavioral Pediatrics, Comer Children's Hospital at the University of Chicago and LaRabida Children's Hospital, Chicago, IL, USA

Steven D. Passik, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Kiran Patel, Division of Nutrition, Department of Bioscience and Biotechnology, Drexel University, Philadelphia, PA 19104, USA

Robert A. Prather, Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA

Richard Ries, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA

Lauren J. Rogak, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, and Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 307 E. 63rd Street, 2nd Floor, New York, NY, USA 10065

Mitchell H. Rosner, Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22908, USA

Miguel R. Sanchez, Division of Dermatology, University of Washington, Seattle, WA 98104, USA

Gabriel Sarah, Health Sciences Center, University of Arizona, Tucson, Arizona, USA

Carol Schneiderman, Section of Infectious Diseases, University of Arizona, Tucson, Arizona, USA

Joel M. Silberberg, Division of Psychiatry and Law, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

C. Chapman Sledge, Chief Medical Officer at Cumberland Heights, and Secretary at American Society of Addiction Medicine, Nashville, TN 37209, USA

Zili Sloboda, Institute for Health and Social Policy, The University of Akron, Akron, OH, USA

Tatiana D. Starr, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Myles Stone, Section of Infectious Diseases, University of Arizona, Tucson, Arizona, USA

Kathryn M. Tchorz, Associate Professor of Surgery, Division of Trauma/Surgical Critical Care/Emergency General Surgery, Wright State University-Boonshoft School of Medicine, Miami Valley Hospital, Dayton, OH 45409, USA

Benita J. Walton-Moss, John Hopkins University School of Nursing, Baltimore, MD, USA

Erin L. Winstanley, Lindner Center of HOPE, Mason, OH 45040, USA, and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA

Christine Yuodelis-Flores, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA

Preface

Drug and alcohol addictions occur commonly in medical populations; 25–50% of patients seen by primary care physicians have alcohol and drug disorders, with even higher prevalence in certain medical specialty populations. Drug addiction, alcohol addiction, and what has been called unhealthy drinking are even more common and prevalent in trauma centers and our society. Injury due to excess and dangerous consumption of alcohol causes almost 25% of trauma center admissions. Currently, there are no authoritative addiction texts with a focus on the identification, intervention, and management of either “addictive disorders in medical populations” or “medical complications in addiction populations”. This book will be useful for those seeking information to help a patient or family with a tobacco, alcohol or drug problem.We hope this book can give answers and a direction to the identification and management of addictions and their medical complications in patient populations.

The death rate for alcohol-related injury patients after discharge is almost 200% higher than that of injury patients who were not drinking. Yet it was not until 2007 that the American College of Surgeons Committee on Trauma implemented a requirement that all Level I trauma centers have a way to provide alcohol screening and intervention to patients. Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has established and helped get codes for the Screening, Brief Intervention, Referral and Treatment (SBIRT) initiative to expand the physician and health professional treatment support and capacity for substance use and addiction. Addictive Disorders in Medical Populations covers this subject in depth as far as what to say and do as well as providing additional resources for the MD.

Neurobiological progress in the field of addiction has been amazing and evidence-based treatments have developed at a phenomenal pace, with bench to office applications for tobacco, alcohol, and drugs. Pharmacological and psychosocial treatments are covered in detail in this book, in clear practical terms. The medical and mental complications of addiction are explained comprehensively throughout the text. Clinical considerations are the predominant theme; however, the standards of clinical practice described in Addictive Disorders in Medical Populations are grounded in the most current research. The chapters have consistent organization, which includes uniform, plentiful, and practical presentations of both clinical and research materials. The authors are leaders in theirfields, selected from the respective general medical and specialty areas.

We know all too well that most, if not all, MDs in practice today did not have the benefit of learning about the neuroscience of addiction and substance addiction when they learned their basic sciences in medical school. Worse yet, if they learned addiction and misuse identification, interventions, and treatment, it was from a book. Imagine learning examinations or labor and delivery by reading a book alone, without clinical correlation and context. When we started mandatory two-week addiction medicine clerkships for all University of Florida medical school students, we hoped but did not envision how much that would change our hospitals and the College of Medicine. Knowing where we are, we hope that this book bridges the gap between what the practicing health provider or specialist needs to know and what they have learned the hard way.

Norman S. Miller and Mark S. Gold

Acknowledgments

As Editors, we would like to acknowledge the work of Rachel Griffen and Paula Edge on this project.

Rachel Griffen's contributions were vital to recruiting authors for this groundbreaking book. She devoted herself to sustained effort in liaising with the authors until delivery of the manuscripts and deserves the heartfelt thanks of the editors who relied totally on her skill and dedication as managing editor.

Paula Edge showed keen editorial abilities and dedication to her craft in managing the editorial review process and bringing the project to successful completion.

Norman S. Miller and Mark S. Gold

Part One

Addictive disorders and medicine

1

Addictive disorders as an integral part of the practice of medicine

Norman S. Miller1 and Mark S. Gold2

1Department of Medicine, Michigan State University, East Lansing, Michigan 48824, USA and Department of Psychiatry, The University of Florida, Gainesville, FL 32611, USA

2Departments of Psychiatry, Neuroscience, Anesthesiology, Community Health & Family Medicine, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL 32611, USA

1.1 OVERVIEW

The role of physician in the prevention and treatment of addictive disorders is growing in importance and magnitude. The public and managed care organizations are increasingly looking to physicians for leadership and advocacy for patients who have drug and alcohol addictions. The political climate and enormous need combine to make the role of physicians essential to prevention and treatment strategies for addictive disorders. Efforts by physicians in the past have been slow and obstructionist, partly because of moral views and lack of training in addiction problems and disorders. Physicians who were not prepared to confront patients about their addictions and non-physicians who could treat, but not communicate with the physicians, competed for the overall care of the patients. Frequently, patients had to bridge the gap at the expensive cost of delay in prevention and diagnosis of problematic use of alcohol and drugs.

Heretofore, physicians played a supporting role, or no role at all, in fostering and developing effective prevention and treatment methods for addictive disorders. The attitude of “see no evil, hear no evil, do no evil” no longer allows physicians to ignore common alcohol and drug problems in their patients. Increasingly, generalists are called upon to screen, detect, prevent, and treat alcohol and drug disorders in their populations.

The challenge to medical schools and resident training programs to provide education and clinical experience in addiction has never been greater or more pressing. In the past, despite the presence and affects of alcohol and drug-related disorders, medical schools and residency programs failed to competently teach screening, diagnosis and treatment of such disorders to students. Increasingly, medical students and residents became aware of the need and demonstrated interest in becoming knowledgeable and skilled in the prevention and treatment of alcohol and drug addiction. Both residency directors and curriculum deans affirmatively endorsed that assessment of deficiencies in training and education for alcohol disorders would lead to significant improvements in medical education for residents and medical students. As a result, medical schools and psychiatry residency programs (at least in the major university settings) are integrating addiction education and experience into their programs [1].