Addiction Medicine PDF
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OXFORD MEDICAL PUBLICATIONS Addiction Medicine i ii Oxford Specialist handbooks published and forthcoming General Oxford Specialist Handbooks A Resuscitation Room Guide Addiction Medicine Perioperative Medicine, Second Edition Post-Operative Complications, Second edition Oxford Specialist Handbooks in Anaesthesia Cardiac Anaesthesia Obstetric Anaesthesia Neuroanaethesia Paediatric Anaesthesia Oxford Specialist Handbooks in Cardiology Adult Congenital Heart Disease Cardiac Catheterization and Coronary Intervention Echocardiography Nuclear Cardiology Fetal Cardiology Heart Failure Hypertension Pacemakers and ICDs Oxford Specialist Handbooks in End of Life Care End of Life Care in Nephrology End of Life in the Intensive Care Unit Oxford Specialist Handbooks in Neurology Epilepsy Parkinson’s Disease and Other Movement Disorders Stroke Medicine Oxford Specialist Handbooks in Paediatrics Paediatric Endocrinology and Diabetes Paediatric Dermatology Paediatric Gastroenterology, Hepatology, and Nutrition Paediatric Haematology and Oncology Paediatric Nephrology Paediatric Neurology Paediatric Radiology Paediatric Respiratory Medicine Oxford Specialist Handbooks in Psychiatry Child and Adolescent Psychiatry Old Age Psychiatry Oxford Specialist Handbooks in Radiology Interventional Radiology Musculoskeletal Imaging Oxford Specialist Handbooks in Surgery Cardiothoracic Surgery Hand Surgery Hepato-pancreatobiliary Surgery Oral Maxillo Facial Surgery Neurosurgery Operative Surgery, Second Edition Otolaryngology and Head and Neck Surgery Plastic and Reconstructive Surgery Surgical Oncology Urological Surgery Vascular Surgery iii Oxford Specialist Handbooks Addiction Medicine Noeline Latt Drug and Alcohol Department, Royal North Shore Hospital and Faculty of Medicine, University of Sydney, Australia Katherine Conigrave Drug Health Service, Royal Prince Alfred Hospital, Faculty of Medicine, University of Sydney, Australia John B. Saunders Faculty of Medicine University of Sydney, Australia E. Jane Marshall South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, King’s College London, London, UK David Nutt Psychopharmacology Unit University of Bristol, UK iv Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2009 The moral rights of the authors have been asserted Database right Oxford University Press (maker) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India Printed in China on acid-free paper by Asia Pacific Offset ISBN 978–0–19–953933–8 10 9 8 7 6 5 4 3 2 1 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding. v Foreword The appearance of this major work is a fortunate event for the student and practitioner of addictions treatment. There is a need for people who work in this field to be conversant with both the social and also the biological aspects of substance dependence. A by-product of the ease with which today both materials and cultures can travel across continents has been that the human species has access to an ever widening range of psychoactive substances. The brain's mosaic of mood pathways can be titillated in myriad subtle ways and our bodies seem able to metabolise many potentially toxic substances. Indeed, the breakdown catalyst of ethanol, ethanol dehydrogenase, has been evolu- tionarily important in our transition from fruit eating primate to homo erectus. Our forebears could eat the fermenting fruit lying on the ground, and not have to rely on scaling the heights of the trees. Fermenting fruit became a sophisticated industry—it can sometimes even charge a higher price for its ageing products, which is an ingenious marketing device. For alcoholic beverages, multinational business ensures that the breadth of choice is getting ever wider. World Trade Agreements indi- rectly aid availability. There are limits however. The radio-astronomical discovery 6 years ago of a galaxy several light years away, whose atmos- phere is made up principally of ethanol vapour, does not announce the extension of Trade Agreements to outer space. As long as societies wish to care for those who become ill, whether or not through their recreation or lifestyle or diet, there will be a growing need for health and social carers to understand addictions. They will find this magnificent scholarly textbook, representing huge dedication by many writers, a boon and a blessing to their studies and their labours. Jonathan Chick University of Edinburgh, Scotland This page intentionally left blank vii Preface Origin of the handbook This Handbook of Addiction Medicine is the result of many years preparation by a group of us who have been clinicians, teachers and researchers in the alcohol and drug field in Australia and the United Kingdom. It has its origins in a series of clinical protocols that were originally developed by one of us (JBS) in the mid-1970s, which then formed the basis of lecture courses in the University of London. The protocols and lecture notes have been developed progressively since then, and have been made available to successive groups of students and practitioner colleagues in Australia and the UK. In preparing the Handbook of Addiction Medicine we sought the contributions of fellow specialists in several countries to produce a contemporary, clinically-grounded text that summarizes the theory and the practice of addiction medicine. Evidence and practice The material in this handbook is informed by the evidence base—the clinical trials and systematic reviews of study findings, and the underpin- ning science. It also draws upon our clinical practice and experience, as it has been shaped over the years to respond to changing patterns of sub- stance use and various interventions that have been developed. All the approaches described have been thoroughly tested in practice and are what we employ in our daily work. Who is this book for? The handbook is intended as a concise and practical guide for students and practitioners of medicine and other health professions who come into contact with people with substance use disorders. This means just about every student and practitioner! More specifically, it is designed for medical students, postgraduate trainees in internal medicine, psychiatry and general (family) practice, trainees in addiction medicine, and estab- lished practitioners and specialists in these areas. We believe it will also be useful and relevant to nurses, psychologists, counsellors, and other clinicians, and for specialist multi-disciplinary agencies providing treatment for people with substance use disorders. Why is this book important? Substance use rates amongst the top four risk factors contributing to the global burden of disease. Substance use disorders can cause, mimic, under- lie, or complicate a large number of common medical and psychiatric disorders. They contribute immense personal suffering, as well as cost to society, which is often not well recognized. Patients may be reticent about revealing their substance use and may not see its relevance. The fact that viii PREFACE many patients use more than one substance, adds to the complexity of the problem. Making a correct diagnosis of the substance use disorder can facilitate clinical diagnosis, avoid unnecessary tests, shorten hospital stay and make the clinician and patient’s life easier—and safer! Increasingly, the ability to diagnose and initiate management of substance use disorders is the responsibility of all medical and health professionals. Traditionally, however, they have not been confident in managing alcohol and drug problems. The knowledge base and the skill set required for good profes- sional practice in this field has been increasingly defined. Addiction Medicine now has a range of treatments that compare in their effectiveness to those in other areas of medicine. What is covered? The handbook provides a practical and easy reference guide to the management of people with substance use disorders. As the text is confined to disorders relating to psychoactive substances, it does not cover gambling or electronic addiction. The first chapter outlines impor- tant background information and summarizes the principles of addiction medicine. It encompasses the epidemiology of psychoactive substance use, the pharmacology and neurobiology of the major substances, and the natural history of the main clinical disorders. The following two chapters summarize the principles of assessment and diagnosis and management that inform the practice of addiction medicine. Following this there are seven chapters on specific types of psychoactive substance, in which the main clinical syndromes associated with that particular substance type and aspects of management that are specific to that substance are described. The remainder of the handbook is devoted to management of specific groups and in specific circumstances and places addiction medicine within the broad professional and legal context. The needs and relevant treatments for particular age and socio-economic groups are described, together with the more complex clinical situations, such as pain and dependence and psychiatric co-morbidity. Following the main text there are a series of appendices which provide summaries of concepts and practical tools to aid management. The handbook provides detailed guidelines on how to obtain a history of alcohol and other drug use, as well as assessment and diagnosis of the core clinical syndromes and related medical and psychosocial problems. In it you will also find practical guides to the range of treatments avail- able, including early intervention, management of withdrawal syndromes (‘detoxification’), pharmacotherapies for relapse prevention, and other management approaches, such as psychological therapies, supportive approaches, and group programmes. ix Contents Acknowledgements x Authors and editors xi Contributors xv Glossary xviii Detailed contents xix Symbols and abbreviations xxvii 1 The scope of addiction medicine 1 2 Assessment and diagnosis: general principles 35 3 Approaches to management 55 4 Alcohol 65 5 Tobacco 143 6 Sedative hypnotics 167 7 Cannabis 187 8 Opioids 199 9 Psychostimulants 239 10 Other drugs 271 11 Psychiatric co-morbidity 295 12 Special populations 311 13 Specific clinical syndromes 353 14 Difficult and urgent situations 379 15 Legal and ethical issues 399 Appendix 417 Index 447
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