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Denial Is Not Just a River in Egypt!

       Denial Can Take Many Different Forms

       CHAPTER FOUR

       There’s an App for That!

       Medically Managed Detoxification

       Opiates/Opioids

       Stimulants

       Alcohol

       Sedative-Hypnotics

       CHAPTER FIVE

       Getting with the Program

       Medication-Assisted Treatment and Recovery

       Antabuse

       Naltrexone

       Campral

       Opiate/Opioid Substitution

       Methadone

       Buprenorphine

       CHAPTER SIX

       Which Came First, the Chicken or the Egg?

       Addiction, Comorbid Psychiatric Disorders, and Psychotropic Medications

       Depressive Disorders

       Anxiety Disorders

       ADHD

       Bipolar Disorder

       Schizophrenia

       Cognitive Behavioral Therapy (CBT)

       Dialectical Behavior Therapy (DBT)

       Motivational Interviewing (MI)

       CHAPTER SEVEN

       What a Pain in the . . .

       Addiction and Chronic Pain

       The Making of an Epidemic

       Pseudoaddiction

       Methadone for Pain

       Weighing the Cost and Benefits of Using Opioids in Treating Chronic Pain

       CHAPTER EIGHT

       Cirrhosis Is NOT One of the Knights of the Round Table

       Addiction and Comorbid Medical Conditions

       Alcohol

       Injection Drug Use

       Stimulants

       CHAPTER NINE

       You People Are Really Sick!

       Addiction and Infectious Diseases

       Hepatitis

       Hepatitis C

       HIV and AIDS

       TB

       Sexually Transmitted Diseases (STDs)

       CHAPTER TEN

       Look into My Eyes—You’re Getting Very Sleepy!

       Addiction and Sleep Problems

       CHAPTER ELEVEN

       What’s the Matter with Kids Today?

       Adolescents and Addiction

       Adolescents Are Different

       Special Considerations for Adolescent Treatment

       Inhalants

       Club Drugs

       Bath Salts

       Hallucinogens

       Anabolic Steroids

       CHAPTER TWELVE

       Using for Two

       Addiction and Pregnancy

       CHAPTER THIRTEEN

       I’d Walk a Mile for a Camel—If I Could Only Catch My Breath

       Nicotine Addiction and Smoking Cessation

       CHAPTER FOURTEEN

       Process Addictions: Gambling, Food, and Sex, Oh, My!

       Pathological Gambling

       Eating Disorders

       Sex Addiction

       CHAPTER FIFTEEN

       Passing a Drug Test Won’t Get You into College (But It Will Help You Stay Out of Trouble)!

       APPENDIX A

       Recovery, Diet, and Nutrition

       APPENDIX B

       Patient Guidelines for Early Recovery

       APPENDIX C

       The California Society of Addiction Medicine’s Position on Medical Marijuana

       RESOURCES

       Twelve-Step Mutual-Aid and Support Programs for Addicts

       Non-Twelve-Step Mutual-Aid and Support Programs for Addicts

       Twelve-Step Mutual-Aid and Support Programs for Family Members and Significant Others

       National Agencies

PREFACE

      Addiction Medicine

      Closing the Gap Between Science and Practice

      Forty million Americans ages twelve and older have an addiction involving nicotine, alcohol, or other drugs, making addiction a disease affecting more Americans than heart conditions, diabetes, or cancer, according to a five-year national study released June 2012 by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are at-risk substance users—using tobacco, alcohol, and other drugs in ways that threaten health and safety.

      The report, Addiction Medicine: Closing the Gap Between Science and Practice, reveals that while seven in ten people with diseases such as hypertension, major depression, and diabetes receive treatment, only about one in ten people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.

      The CASA Columbia report found that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment, and disease-management tools and practices exist, they are rarely employed. The report exposed the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and that most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills, or credentials necessary to provide the full range of evidence-based services.

      “This report shows that misperceptions about the disease of addiction are undermining medical care,” said Drew Altman, PhD, president of The Henry J. Kaiser Family Foundation, who chaired the report’s National Advisory Commission. While doctors routinely screen for a broad range of health problems such as high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction, and instead treat a long list of health problems that frequently result from it, including accidents, unintended pregnancies, heart disease, and many other costly conditions, without examining the root cause.

      This landmark report examines the science of addiction—a complex disease that involves changes in the structure and function of the brain—and the profound gap between what we know about the disease and how to prevent and treat it, versus current health and medical practice.

      Few Patients with Addiction Receive Quality Care

      The CASA

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