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Concepts of Chemical Dependency, 10th ed. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 cengage.com/mindtap Fit your coursework into your hectic life. Make the most of your time by learning your way. Access the resources you need to succeed wherever, whenever. Study with digital flashcards, listen to audio textbooks, and take quizzes. Review your current course grade and compare your progress with your peers. Get the free MindTap Mobile App and learn wherever you are. Break Limitations. Create your own potential, and be unstoppable with MindTap. MINDTAP. POWERED BY YOU. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 CONCEPTS of CHEMICAL DEPENDENCY 10th edit ion HAROLD E. DOWEIKO Gundersen-Lutheran Medical Center La Crosse, WI With contributions from AMELIA L. EVANS Liberty University Australia ● Brazil ● Mexico ● Singapore ● United Kingdom ● United States Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Important Notice: Media content referenced within the product description or the product text may not be available in the eBook version. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 © 2019, 2015 Cengage Learning, Inc. Unless otherwise noted, all content is © Cengage. ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced or distributed in any form or by any means, except as permitted by U.S. copyright law, without the prior written permission of the copyright owner. For product information and technology assistance, contact us at Cengage Customer & Sales Support, 1-800-354-9706 or support.cengage.com. For permission to use material from this text or product,submit all requests online at www.cengage.com/permissions. Library of Congress Control Number: 2017962369 ISBN: 978-1-337-56345-1 Cengage 20 Channel Center Street Boston, MA 02210 USA Cengage is a leading provider of customized learning solutions with employees residing in nearly 40 different countries and sales in more than 125 countries around the world. Find your local representative at www.cengage.com. Cengage products are represented in Canada by Nelson Education, Ltd. To learn more about Cengage platforms and services, visit www.cengage.com. To register or access your online learning solution or purchase materials for your course, visit www.cengagebrain.com. Printed in the United States of America Print Number: 01 Print Year: 2018 Concepts of Chemical Dependency, Tenth Edition Harold E. Doweiko Product Director: Marta Lee-Perriard Product Manager: Julie Martinez Content Developer: Nicky Montalvo Product Assistant: Allison Balchunas Marketing Manager: Zina Craft Art Director: Vernon Boes Production Management and Composition: MPS Limited Text and Cover Designer: Jennifer Wahi Cover Image: HamsterMan/Shutterstock. com; Dima Sobko/Shutterstock.com; ImagePixel/Shutterstock.com; chromatos/ Shutterstock.com; VladKK/Shutterstock. com; sirtavelalot/Shutterstock.com; AGCuesta/Shutterstock.com Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 In loving memory of Harold Doweiko. For Jan. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 iv Brief Contents 1 Why Worry About Substance Misuse or Substance Use Disorders? 1 2 The Nature of the Beast 9 3 A Brief Introduction to the Science of Pharmacology 17 4 An Introduction to Alcohol: Man’s Oldest Recreational Chemical 30 5 The Alcohol Use Disorders 46 6 Misuse of Barbiturates and Barbiturate- Like Compounds 63 7 Misuse of the Benzodiazepines and Similar Agents 72 8 Use and Misuse of Central Nervous System Stimulants 87 9 Cocaine Misuse and Cocaine Use Disorder 106 10 Marijuana Use and Misuse 119 11 Opioid Use and Misuse 134 12 Hallucinogen Misuse 159 13 Misuse of Inhalants and Aerosols 177 14 The Under-Recognized Problem of Steroid Misuse 185 15 Tobacco Products and Tobacco Use 195 16 Over-the-Counter Analgesics 211 17 Chemicals and the Neonate 223 18 Gender and Substance Use Disorders 238 19 Hidden Faces of Substance Use Disorders 251 20 Substance Misuse by Children and Adolescents 260 21 Substance Use and Substance Use Disorders in College Students 288 22 Substance Use Disorders and the Older Adult 298 23 Substance Use Disorders and the Family 304 24 Codependency and Enabling 313 25 The Client with Co-Occurring Disorders 323 26 The Biopsychosocial Model of the Addictions 343 27 The Substance Use Disorders as a Disease of the Human Spirit 376 28 The Assessment of Suspected Substance Use Disorders 389 29 Intervention 405 30 Treatment Settings 415 31 The Treatment of Substance Use Disorders 424 32 The Process of Treatment 437 33 Pharmacological Interventions for Substance Use Disorders 448 34 Relapse and Other Problems Frequently Encountered in Substance Rehabilitation 470 35 Support Groups to Promote and Sustain Recovery 493 36 Substance Use Disorders and Infectious Disease 507 37 The Debate over Drugs 522 38 The Debate over Legalization 543 Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 v Preface xiii CHAPTER 1 Why Worry About Substance Misuse or Substance Use Disorders? 1 SUDs as Unsuspected Influences on Society 2 The Scope of the Problem of the SUDs 3 The Cost of Chemical Misuse and SUDs 6 Who Treats Persons with an SUD? 7 Designer Drugs for Pleasure: A (Frightening) Brave New World 8 Chapter Summary 8 CHAPTER 2 The Nature of the Beast 9 Why Do People Choose to Use Drugs or Alcohol? 10 Drug Use/Misuse Cycles 12 The Continuum of Chemical Use 12 What Do We Mean When We Say That Somebody Is “Addicted” to a Chemical? 13 Definitions of Terms Used in This Text 14 Behavioral/Process “Addictions” 15 Unanswered Questions 15 Chapter Summary 16 CHAPTER 3 A Brief Introduction to the Science of Pharmacology 17 A Basic Misconception 17 The Prime Effect and Side Effect of Chemicals 18 The Method by Which a Compound Is Administered 18 Bioavailability 20 The Effective Dose 25 The Lethal Dose and Therapeutic Index 25 Therapeutic Threshold and Peak Effects 26 The Site of Action 26 The Receptor Site 26 The Process of Neurotransmission 27 The Blood-Brain Barrier 29 Chapter Summary 29 CHAPTER 4 An Introduction to Alcohol: Man’s Oldest Recreational Chemical 30 Why Do People Consume Alcohol? 31 A Brief History of Alcohol 31 Alcohol Today 33 How Alcoholic Beverages Are Produced Today 33 A Working Definition of Social Drinking 33 Scope of Alcohol Use in the World Today 34 The Pharmacology of Ethyl Alcohol 35 The Biotransformation of Alcohol 36 The Blood Alcohol Level (BAL) 37 Subjective Effects of Alcohol on the Individual Who Drinks Socially at Normal Doses 38 Medical Complications of Alcohol Use for the Individual Who Drinks Socially 39 Alcohol Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) 45 Chapter Summary 45 Contents Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203 vi CONTENTS CHAPTER 5 The Alcohol Use Disorders 46 A Working Definition of the Alcohol Use Disorders 47 Scope of the Problem 47 Who Is the Typical Person with an Alcohol Use Disorder? 48 Physical Dependence, Tolerance, and “Craving” 49 Complications of Chronic Alcohol Use 50 The Alcohol Withdrawal Syndrome 60 Alcohol Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) 62 Chapter Summary 62 CHAPTER 6 Misuse of Barbiturates and Barbiturate-Like Compounds 63 Early Medical Treatment of Anxiety and Insomnia 63 History and Current Medical Uses of Barbiturates 64 Pharmacology of the Barbiturates 65 Subjective Effects of Barbiturates at Normal Dosage Levels 67 Complications of Barbiturate Use at Normal Dosage Levels 67 Effects of the Barbiturates at Above- Normal Dosage Levels 68 Neuroadaptation, Tolerance, and Physical Dependence on Barbiturates 69 The Barbiturate-Like Drugs 69 Alcohol Use and the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) 70 Chapter Summary 70 CHAPTER 7 Misuse of the Benzodiazepines and Similar Agents 72 Scope of Prescribed Benzodiazepine Use 73 Medical Uses of the Benzodiazepines 73 The Pharmacology of the Benzodiazepines 73 Subjective Effects of Benzodiazepines at Normal Dosage Levels 75 Side Effects of the Benzodiazepines When Used at Normal Dosage Levels 76 Neuroadaptation to, Misuse of, and Addiction to the Benzodiazepines 77 Drug Interactions Involving Benzodiazepines 80 Long-Term Consequences of Chronic Benzodiazepine Use 80 The Benzodiazepine Receptor Antagonists (Z-Compounds or BRAs) 81 Rohypnol 85 Sedative, Hypnotic, or Anxiolytic Use Disorders and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition 86 Chapter Summary 86 CHAPTER 8 Use and Misuse of Central Nervous System Stimulants 87 I. CNS Stimulants as Used in Medical Practice 88 II. CNS Stimulant Misuse 95 CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition 104 Chapter Summary 105 CHAPTER 9 Cocaine Misuse and Cocaine Use Disorder 106 A Brief History of Cocaine 107 Current Medical Uses of Cocaine 108 Scope of the Problem of the Cocaine Use Disorders 108 Pharmacology of Cocaine 109 How Illicit Cocaine Is Produced 111 Methods of Cocaine Misuse 111 Subjective Effects of Misused Cocaine 113 Complications of Cocaine Misuse and Cocaine Use Disorder 113 CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition 118 Chapter Summary 118 CHAPTER 10 Marijuana Use and Misuse 119 A History of Marijuana Use/Misuse 120 Anecdotal Claims of Efficacy 120 Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the