Substance Use Problems

About the Authors

Mitch Earleywine, PhD, is Associate Professor of Clinical Psychology at the University at Albany, State University of New York, where he teaches drugs and human behavior, substance abuse treatment and clinical research methods. He has received 10 teaching commendations, including the coveted General Education Teaching Award from the University of Southern California. His research funding has come from the National Institute on Alcohol Abuse and Alcoholism, the Alcoholic Beverage Medical Research Foundation, and the Marijuana Policy Project. He serves on the editorial boards of four psychology journals, reviews for over a dozen, and has more than 80 publications on drug use and abuse, including “Understanding Marijuana” (Oxford University Press, 2002). He serves on the advisory board for the National Organization for the Reform of Marijuana Laws, and is a member of the Research Society on Alcoholism, the Association for the Advancement of Behavior Therapy, and the Drug Policy Alliance.

Advances in Psychotherapy – Evidence-Based Practice

Danny Wedding; PhD, MPH, Prof., St. Louis, MO

(Series Editor)

Larry Beutler; PhD, Prof., Palo Alto, CA

Kenneth E. Freedland; PhD, Prof., St. Louis, MO

Linda C. Sobell; PhD, ABPP, Prof., Ft. Lauderdale, FL

David A. Wolfe; PhD, Prof., Toronto

(Associate Editors)

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a “reader-friendly” manner. Each book in the series is both a compact “how-to-do” reference on a particular disorder for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

The most important feature of the books is that they are practical and “reader-friendly:” All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls”, marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Substance Use Problems

Mitch Earleywine

Clinical Psychology Department, University at Albany, State University of New York

Library of Congress Cataloging in Publication

is available via the Library of Congress Marc Database under the LC Control Number 2009925364

Library and Archives Canada Cataloguing in Publication

Earleywine, Mitch

Substance use problems / Mitch Earleywine.

(Advances in psychotherapy--evidence-based practice)

Includes bibliographical references.

ISBN 978-0-88937-329-7

1. Drug abuse. 2. Drug abuse--Treatment. I. Title. II. Series: Advances in psychotherapy--evidence-based practice

RC564.E25 2009             616.86‘0651             C2009-901894-2

© 2009 by Hogrefe & Huber Publishers

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Acknowledgments

My hearty thanks to Danny Wedding, Robert Dimbleby, and Linda Sobell for keeping me involved in this project. I thank my clinical supervisees who encouraged me to elaborate on these points. The graduate students who took the substance abuse treatment course in the last 17 years deserve congratulations for keeping me on top of this literature while encouraging me to explain it efficiently. The thousands (!) who took the infamous “Drug Class” kept me excited about these topics by letting me see this field through their eyes. My usual support team also gets unusual kudos: Robert Earleywine, Clark and Suzy Van Scoyk, David and Felice Gordis, Joe Earleywine (who critiqued sections with great candor and minimal ridicule), Jack Huntington, Rob Kampia, Bruce Mirken, Paul Armentano, Allen St. Pierre, Keith Stroup, Marsha Rosenbaum, Ethan Nadelmann, Stanton Peele, and Domenico Scarlatti. My unbridled thanks to Nicholas Van Dam, who deserves an award for reading every word of this document and many that didn’t make it. His comments improved the book dramatically. Special thanks to Michelle Stiles, who turned my free associations into references. I also thank my new support team: The Musketeers (Brad Armour-Garb, Tony DeBlasi, and Larry Kranich), Mike and Valerie Corral, Wendy Chapkis, and Russ Belville. Jenny Rella, Justina Farley, and Bryan O’Neill also get my sincere gratitude.

My daughters, Dahlia and Maya, continue to teach me that no matter how much I may know about genetics and environment, I cannot explain all the variance in behavior. My wife, Elana, continues to show inexplicable support, including astounding clinical skill at dealing with frequent and severe bouts of DMS (drug manuscript syndrome). I dedicate this book to her with love.

But I think I owe the biggest debt to the clients who sat with me as we all crawled, walked, ran, and occasionally flew toward better lives.

Table of Contents

Acknowledgment

1          Description of Problem Drug Use

1.1       Terminology

1.1.1    Diagnostic Terms

1.1.2    Common Drugs

1.1.3    Nonproblematic, Recreational Drug Use

1.1.4    Problematic Drug Use

1.2       Definitions

1.2.1    Dependence

1.2.2    Abuse

1.2.3    Codes from the Diagnostic and Statistical Manual

1.2.4    Drug Problems

1.3       Epidemiology

1.3.1    World Statistics

1.3.2    Demographic Correlates

1.3.3    Recent Use

1.3.4    Abuse and Dependence

1.4       Course and Prognosis

1.4.1    Chronicity

1.5       Differential Diagnosis

1.5.1    Deviant Arousal

1.5.2    Thought Disorder

1.6       Comorbidities

1.6.1    Impulse control disorders

1.6.2    Problem Gambling

1.6.3    Eating Disorders

1.6.4    Attention Deficit Disorders

1.6.5    Conduct Disorder

1.6.6    Personality Disorders

1.6.7    Mood Disorders

1.6.8    Anxiety Disorders

1.6.9    Suicide

1.7       Diagnostic Procedures and Documentation

2          The Biopsychosocial Model of Drug Problems

2.1       Interacting Components

2.2       Initiation

2.3       Regular Use

2.4       Problem Use

2.5       Treatment Outcomes

3          Diagnosis, Assessment and Treatment Indications

3.1       General Guidelines

3.1.1    Assessment IS treatment

3.2       A Note on Taking Notes

3.3       The Timeline Follow-Back (TLFB)

3.3.1    Encouraging Assessment

3.4       The Inventory of Drug Use Consequences (InDUC)

3.5       Motivation to Change

3.6       Treatment History

3.7       Social Support

4          Methods of Treatment

4.1       Overview

4.1.1    Empirically supported treatments (ESTs)

4.1.2    Harm Reduction, Drug Safety, and Abstinence

4.2       Efficacy and Prognosis

4.3       The Therapeutic Relationship as a Mechanism of Action

4.3.1    Empathy

4.3.2    Warmth

4.3.3    Genuineness

4.4       Combinations of Methods

4.4.1    Motivational Interviewing

4.4.2    Mutual Help and Self-Help Groups

4.4.3    Meditation Techniques

4.4.4    Psychopharmacological Adjuncts to Treatment

4.5       Multicultural Issues

5          Further Readings

6          References

7          Appendix

        Inventury of Drug Use Consequences

        Shortened Inventory of Problems – Alcohol and Drugs

1

Description of Problem Drug Use

1.1     Terminology

This first section reviews diagnostic terms, epidemiology, prognosis, differential diagnosis, comorbidities, and diagnostic procedures for drug-related problems. A clear understanding of each of these topics will lay a foundation for efficient assessment and treatment.

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!