This book has been written to serve as a manual for physicians practicing in a private office setting to recognize and recommend appropriate treatment for patients believed to be substance abusers. While it is not written for drug abuse specialists, it provides information regarding the diagnosis and treatments a competent, concerned physician can provide without becoming immersed in addiction treatment. Topics discussed include the degree to which a physician should become involved, when it is appropriate to refer, using other professions and volunteer groups, and useful medications. Guidelines for recognizing substance abuse, testing to confirm the abuse, confronting the patient, and motivating the patient into specific treatment are also presented. Tables and illustrations are used to summarize major points, making this an extremely useful reference tool for internists and other non-specialist private practitioners.
BACKGROUND. Introduction to Abused Substances. Terminology, Definitions, FDA Classifications, DSM III R Diagnostic Criteria. Molecular Basis of Action of Abused Substances. Etiology of Substance Abuse; Similarities of Alcohol and Drug Abuse. Essential Pharmacology of Abused Drugs. Issues of Law and Custom. Attitudes Among Medical Staff Influencing Substance Abuse Care. SKILLS. Obtaining an Accurate Drug and Alcohol History. Recognition of the Alcoholic and Substance-Abusing Patient in Your Practice. Emergencies in Drug and Alcohol Use and Their Management. Laboratory Use in Screening and Verification of Drug Use. Cost-Effective Screening of Addicted Persons for Significant Illness. Classes of Drugs Needed for the Successful Management of Addiction. Informing the Patient of the Diagnosis of Abuse and Motivating Him to Treatment. SUBSTANCES AND THEIR SPECIFIC PROBLEMS. What Can Be Learned from Smoking and Nicotine Addiction. Alcohol and Sedatives. Medical Problems in Alcoholics. Psychiatric Problems in Addicts. Opium Derivatives. Medical Problems Related to illicit Drugs. Cocaine and Amphetamines. Marijuana. Hallucinogens and Phencyclidine. Miscellaneous Abused Drugs. Mixed Drug Abuse. TREATMENT AND REHABILITATION. What Is Treatment and What Does It Accomplish? Drug Withdrawal: Recognition and Treatment. Entering Treatment. Professionals and Others Providing Skilled Services to Substance Abusers. The Range of Treatment and Rehabilitation Programs: Factors in the Selection of an Appropriate Program. Setting and Meeting Realistic Goals for Rehabilitation. Volunteer Groups in the Treatment of Addictions: The Model of Alcoholics Anonymous. Crises in Treatment. Prevention and Pertinent Public Health Issues. SPECIAL GROUPS. Special Problems of Substance Abuse in Adolescence. Special Problems in Women Abusers. Problems of Addiction During Pregnancy and Problems in the Child. Children of Alcoholics and Drug Abusers. Alcoholism and Addictions in the Elderly. Addictions in Ethnic and Special Social Groups. Abuse in Professionals. Glossary.