Table Of ContentMMMM
This page intentionally left blank
DrugsandAddictiveBehaviour
In this completely revised and updated third edition of his highly successful book, Hamid
Ghodsepresentsa comprehensiveoverview of substancemisuse and dependence.Thereis a
particular emphasis on practical, evidence-basedapproaches to the assessmentand manage-
mentofawiderangeofdrug-relatedproblemsinavarietyofclinicalsettings,andhehaswritten
anentirelynewchapteronalcoholabuse.HedeWnesalltheterms,anddescribestheeVectsof
substance misuse on a patient’s life. Epidemiology, and international prevention and drug
control policies are covered to address the global nature of the problem, and the appendix
provides a series of clinical intervention tools, among them a Substance Misuse Assessment
Questionnaire.
Thiswillbeessentialreadingforallcliniciansandotherprofessionalsdealingwithaddiction,
fromcounsellorsandsocialworkerstopolicymakers.
HamidGhodseisProfessorand Directorofthe CentreforAddiction Studiesat StGeorge’s
HospitalMedicalSchoolinLondon.HeisalsotheDirectoroftheBoardofInternationalAVairs
of the Royal Collegeof Psychiatrists and memberof the ExpertAdvisory Panelof WHO on
Alcohol and Drug Dependence. He has been six times president of the UN International
NarcoticsControlBoard.
MMMM
Drugs
Addictive
and
Behaviour
AGuideto Treatment
Third edition
Hamid Ghodse
CBE(Hon.)MDPhDFFPHMFRCPFRCPEFRCPsych
ProfessorandDirector,CentreforAddictionStudies
DepartmentofAddictiveBehaviourandPsychologicalMedicine
StGeorge’sHospitalMedicalSchool,UniversityofLondon
HonoraryConsultantPsychiatrist
SouthWestLondonandStGeorge’sMentalHealthTrust
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo
Cambridge University Press
The Edinburgh Building, Cambridge , United Kingdom
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521813549
© Cambridge University Press 2002
This book is in copyright. Subject to statutory exception and to the provision of
relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.
First published in print format 2002
-
isbn-13 978-0-511-06477-7 eBook (NetLibrary)
-
isbn-10 0-511-06477-2 eBook (NetLibrary)
-
isbn-13 978-0-521-81354-9 hardback
-
isbn-10 0-521-81354-9 hardback
isbn--13 978-0-521-00001-7 paperback
-
isbn-10 0-521-00001-7 paperback
Cambridge University Press has no responsibility for the persistence or accuracy of
s for external or third-party internet websites referred to in this book, and does not
guarantee that any content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and up-to-date
information which is in accord with accepted standards and practice at the time of
publication. Nevertheless, the authors, editors and publishers can make no warranties
that the information contained herein is totally free from error, not least because
clinical standards are constantly changing through research and regulation. The authors,
editors and publisher therefore disclaim all liability for direct or consequential
damages resulting from the use of material contained in this book. Readers are strongly
advised to pay careful attention to information provided by the manufacturer of any
drugs or equipment that they plan to use.
Whenyou cancurebyregimen,
avoid havingrecourseto medicine;
andwhenyou caneVecta cure
bymeansofa singlemedicine,
avoid usinga compoundone.
Razi(Rhazes)
Persia,AD850–922
ToBarbara,Amir-Hossein,NassrinandAli-Reza
Contents
Preface xi
Introduction xiii
1 Drugs,addictionandbehaviour 1
Whatisa‘drug’? 1
Whatisdrugmisuse? 2
Drugabuse;harmfuluse 3
Drugdependence 3
Psychologicaldependence 4
Physicaldependenceandthewithdrawalsyndrome 5
Tolerance 6
Typesofdrugdependence 8
Causesofdrugdependence 10
2 DrugdependenceintheUK–andelsewhere 23
DrugdependenceintheUK 23
Drugpolicyinothercountries 33
OrganizationoftreatmentservicesintheUK 37
SourcesofepidemiologicalinformationintheUK 43
Internationalinformationondrugabuse 69
Globaldrugproblems 77
3 Drugsofabuseanddependence 95
Opioids 95
Sedativehypnotics 106
Stimulant drugs 113
Hallucinogens 123
vii
viii Contents
Cannabis 127
Volatilesolvents 132
Designerdrugs 135
Steroids 138
Overthecountermedicines 140
Herbalpreparationsand‘natural’medicines 140
Thecombineduseofdrugsandalcohol 141
4 Alcohol 143
Introduction 143
DeWnitions 143
Extentandnatureoftheproblem 145
Alcoholmetabolism 149
AdverseeVects 150
Managementofproblemdrinkinganditscomplications 152
Relapseprevention 156
Alcoholpolicies 159
5 Assessment 163
Introduction 163
Drughistory 164
Lifehistory 165
Socialworkassessment 170
Familyassessment 172
Physicalexamination 173
Testofphysicaldependenceonopiates(naloxonehydrochloride) 176
Mentalstateexamination 177
Psychologicalassessment 180
Specialinvestigations 180
Laboratoryinvestigationfordrugs 183
ClassiWcationofsubstance-usedisorders 190
6 Generalmeasuresofintervention 211
Introduction 211
Psychotherapy 213
Drugcounselling 218
Description:This book deals with all aspects of substance abuse and drug dependence. In the book, current drug problems are set against historical and epidemiological perspectives and theoretical topics are also included. The book aims to provide clear practical guidance on the assessment and management of all
