Table Of Content -
Editors
Textbook of
Addiction
Treatment:
International
Perspectives
1 3
Reference
Textbook of Addiction Treatment:
International Perspectives
Nady el-Guebaly (cid:129) Giuseppe Carra`
Marc Galanter
Editors
Textbook of Addiction
Treatment: International
Perspectives
With67Figuresand117Tables
Editors
Nadyel-Guebaly MarcGalanter
DivisionofAddiction DivisionofAlcoholismandDrugAbuse
DepartmentofPsychiatry NYUSchoolofMedicine
UniversityofCalgary NewYork,USA
AlbertaGamblingResearchInstitute
Calgary,AB,Canada
GiuseppeCarra`
UCLDivisionofPsychiatry
FacultyofBrainSciences
UniversityCollegeLondon
London,UK
ISBN978-88-470-5321-2 ISBN978-88-470-5322-9(eBook)
ISBNBundle978-88-470-5323-6(printandelectronicbundle)
DOI10.1007/978-88-470-5322-9
SpringerMilanHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2014952301
#Springer-VerlagItalia2015
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Foreword
Substance use and abuse is widespread around the world. There are clear cultural
differencesbetweencountriesandsometimesevenwithinthesamecountryregarding
theuseandabuseofsubstances.Variousculturalandsocialfactorsplayanimportant
roleindefiningandtreatingpatternsofsubstanceabuse.Reasonsforsubstanceuse
andabusevaryfromgenetic,social,andpsychological.Dependinguponthedegree
ofabuseandrecognitionofthepatternsofabuse,helpmaybesoughtfromanumber
ofsources.Culturesandsocietiesdictatehowresourcesareallocatedandhowpeople
are encouraged to use certain pathways into care. Identifying the unmet needs and
mentalhealthgapinthefieldofsubstanceuseandabuseisthefirstcrucialstep.
Thisreferencetext–asignificantoutputfromtheInternationalSocietyofAddic-
tionMedicine–meetstheaimsoftheSociety.Theseaimsareeminentlylaudableas
they recognize the role of physicians in treating and managing addictions. The key
challengesremainingincludepolicydifferencesacrosscountriesandhowthesemust
beaddressed.Furthermore,trainingofallhealthprofessionalsinrecognizingphysical
andpsychiatricproblemsassociatedwithsubstanceabuseisamust.Dependingupon
human and financial resources, perhaps a tiered approach may be indicated. Physi-
cians in partnership with others have a significant role to play in a public mental
health agenda. Substance abuse – varying from tobacco to drugs, prescribed or
otherwise – is a major challenge in the field of public mental health. The editors
have done a sterling job in bringing together over 250 authors from a rich global
backgroundtohavesharedtheirexpertiseandexperiences.Thisvolumeprovidesan
excellent introduction at an international level to epidemiology, biological, social,
and psychological interventions and recognition of medical consequences and
comorbidities.Theeditorsdeserveourcongratulationsonajobwelldone.
DineshBhugra
F.R.C.P.,F.R.C.P.E.,F.R.C.Psych.,F.F.P.H.,M.Phil.,Ph.D.
ProfessorofMentalHealth&CulturalDiversity
InstituteofPsychiatry,King’sCollegeLondon
HealthService&PopulationResearchDepartment
London,UK
President,WorldPsychiatricAssociation
v
vi Foreword
Thepastdecadehaswitnesseddisturbinggrowthintheprevalenceanddiversityof
substanceuseproblemsthroughouttheworld.Firstconsidereda“USproblem”and
later a problem “of the Western world,” substance abuse and addiction are now
clearlyworld-wideproblemsproducingdramaticallygreaterlossoflife,morbidity,
andcoststhanvirtuallyanyotherhealthcondition.
Perhaps because addictions have been so prevalent and serious in the USA for
thepast40years,over80%ofpublishedclinicalresearchonaddictiontoalcohol
and other drugs of abuse has been done by the USA and other English-speaking
investigators. But this body of work has at best only partially informed our
understanding of how to prevent and treat addiction. This is because so many
factors that contribute to susceptibility to initial substance use; transition from
voluntary use to uncontrolled addiction; and to treatment entry, adherence,
and effectiveness are determined as much by environmental, family, and
interpersonal forces as they are by genetics and metabolism. These factors
vary substantially across countries and cultures. Thus, world understanding
about how to prevent, intervene early, and treat addiction will require far more
diversestudy.
In this context, the ISAM Textbook of Addiction Treatment, with its broad and
diverse contributions representing 265 scientists and 30 countries, is a timely and
welcome addition to worldwide understanding on how to intervene and treat
addictions.Inparticular,theTextbookintroducesawiderangeofnewperspectives
on the development of substance use disorders and a number of previously
unreported interventions to reduce the prevalence, severity, and associated harms
fromsubstanceabuseandaddiction.
To be sure this Textbook will not resolve decades-long controversies in
optimal prevention, intervention, and treatment responses, there is still too little
information and too many preexisting views to yet achieve consensus. But this
Textbook signals something that has frankly been lacking in US-dominated
research and treatment of addiction: a willingness to incorporate, evaluate, and
includeeffectivenewapproaches,methods,andtools.Itisclearthatnocountry,
profession,ortheorycanclaimadequatesuccessinpreventingortreatingaddic-
tion to justify the all-too-common political, financial, and even scientific resis-
tance to new methods.
If there is a need to reduce diversity, it is in our methods of diagnosing
substance use disorders, in articulating common goals of treatment, and in
adoptingcommonmeasuresandmethodsforevaluatingtreatmentaccess,adher-
ence,andeffectiveness.Thesekindsofconsensusstandardsshouldhelpthisstill-
developingfieldofpublicandclinicalhealthtoidentifyandagreeuponeffective
Foreword vii
new interventions. This is an obvious and needed role for the International
Society of Addiction Medicine and should be a natural outgrowth of continued
international collaboration and sharing of results through venues such as this
Textbook.
A.ThomasMcLellan
CEO,TreatmentResearchInstitute
Philadelphia,PA,USA
FormerDeputyDirector
OfficeofNationalDrugControlPolicy
USA
Theinitiativetowriteatextbookaddressingtheglobalaspectsofaddiction,whether
prevalence, types, and methods of abuse or different management approaches, is
unique and welcome. The chapters are comprehensive to deal with all psychoso-
cial–biological aspects of addiction. Psychoactive substance use poses a significant
threat to the health, social, and economic fabric of families, communities, and
nations.Theextentofworldwidepsychoactivesubstanceuseisestimatedat2billion
alcoholusers,1.3billionsmokers,and185milliondrugusers.
In an initial estimate of factors responsible for the global burden of disease,
tobacco,alcohol,andillicitdrugscontributedtogether12.4%ofalldeathsworld-
wide in the year 2000. Looking at the percentage of total years of life lost due to
thesesubstances,ithasbeenestimatedthattheyaccountfor8.9%.
The level of economic development in countries also plays an important role.
Theburdenfrompsychoactivesubstanceuseishigherindevelopedcountriesthan
especiallyinhigh-mortalitydevelopingcountries.Thesexratiofortheattributable
deathsofpsychoactivesubstanceusevariesfrom80%malefortobaccoandillicit
druguseto90%foralcohol.WithregardtoDALYs,itisbetween77%and85%
for all substances. The largest proportion of DALYs is on males in developed
countries, where psychoactive substance use accounts for 33.4 % of all DALYs
(WHOWebsite).
WHO seeks to promote the concept of health for all through its strategy of
reducingtheincidenceandprevalenceofpsychoactivesubstanceuseandproviding
the best available evidence on the management of substance-related problems.
The achievement of this goal is designed to lead to reductions in the demand for
psychoactive substances and to reduce the health and social problems associated
withsuchuse.
viii Foreword
The debate that we are criminalizing cannabis while decriminalizing alcohol
and tobacco in spite of their higher disease burden is controversial (Okasha
2008). The use of replacement therapy in addiction in developed countries may
be unavailable in emerging countries. What are the alternatives? We have
contradictory feedback from different countries. I believe this book will
enlighten those working in the mental health of addiction in different devel-
oped, emerging, or developing countries to comprehend the complexity of the
problemofaddictionandthenecessitytouseflexibleprogramsaccordingtothe
norms, culture, and economy of the country.
References
OkashaA(2008)Introductiontotheforum:iscannabisconsumptionalifestyleor
braindisease?CurrOpinPsychiatry21(2):114–115
WHOWebsite.http://www.who.int/substance_abuse/facts/global_burden/en/
Prof.AhmedOkasha
M.D.,Ph.D.,F.R.C.P.,F.R.C.,Psych.,F.A.C.P(Hon.)
DirectorofWHOCollaboratingCenter
ForResearchandTraininginMentalHealth
InstituteofPsychiatry,AinShamsUniversity,Cairo,Egypt
PastPresident,WorldPsychiatricAssociation
Preface: What Does an International
Perspective Bring?
The International Society of Addiction Medicine (ISAM) was founded in Palm
Springsin1999.Fromtheonset,theelementsofitsmainmissionwere
• Advancementoftheknowledgeofaddictionasatreatabledisease
• Recognition that physicians worldwide have a major role to play in the man-
agementofaddiction
• Enhancementofthecredibilityofthephysician’srole
• Emphasisoftheimportanceofeducationalactivities
• Establishmentofconsensusdocumentsandpracticeguidelines
To implement this mission, the Society has organized an annual meeting ever
since. This major gathering has also been supplemented on a few occasions with
regional meetings. The Society also cosponsors the journal Substance Abuse.
To pursue the mission, an International Certification in Addiction Medicine was
createdin2005andhasbeenadministeredannuallyonatotalof15occasions.
InseekingreferencetextstocreatetheexaminationquestionsfortheCertifica-
tion, it became evident that the three or four excellent multiauthored textbooks
available in English all originated from the USA, with an occasional contribution
from an author from another country. These books are heavily centered on data
arising from an American context and culture. We decided that a textbook with
a broader authorship representation was required as well as a search for data
originatingfromacrosstheworld.Mindfulofthefactthatauthorswouldpotentially
havedifferentdegreesofEnglishproficiency,wedividedthescopeofourchapters
into overview, focused, and sidebar chapters for case studies. International strate-
gies to address substance abuse have traditionally favored control of the supply
of drugs rather than reduction of the demand for their use. This textbook aims
to describe the multifaceted options available for culturally sensitive strategies
prioritizingdemandreduction.
This international textbook is divided into 12 sections, resulting from the
collaborative efforts over 3 years of some 265 contributors from 30 countries.
Thesesectionsoutlinethecomponentsofaninternationalperspective.
Abroaderunderstandingofepidemiology,etiology,andprevention
Theprevalenceofdrugintakeisdeterminednotonlybyindividualstressfactorsbut
also regional and larger-scale cultural patterns of drug consumption, social role
models,aswellaslegalrequirementsandprohibitions.
ix
