Manual of Drug and Alcohol Abuse: Guidelines for Teaching in Medical and Health Institutions

333 Pages·1988·12.03 MB·English

by  Awni Arif

Manual of Drug
and Alcohol Abuse
Guidelines for Teaching in
Medical and Health Institutions
Manual of Drug
and Alcohol Abuse
Guidelines for Teaching in
Medical and Health Institutions
Edited by
Awni Arif, M.D.
Formerly of the World Health Organization
Geneva, Switzerland
and
Joseph Westermeyer, M.D., Ph.D.
University of Minnesota Hospital and Clinics
Minneapolis, Minnesota
Plenum Medical Book Company • New York and London
Library of Congress Cataloging in Publication Data
Manual of drug and alcohol abuse.
Includes bibliographies and index.
1. Substance abuse. 2. Alcoholism. 1. Arif, A. E. II. Westermeyer, Joseph, 1937-
[DNLM: 1. Alcoholism. 2. Substance Abuse. WM 270 M2938]
RC564.M26 1988 616.86 88-22414
ISBN-13: 978-1-4615-9518-2 e-ISBN-13: 978-1-4615-9516-8
DOl: 10.1007/978-1-4615-9516-8
© 1988 Plenum Publishing Corporation
Softcover reprint of the hardcover 1s t edition 1988
233 Spring Street, New York, N.Y. 10013
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Acknowledgments
We wish to thank those who have contributed extensive time and materials in the
development of this work. Most have contributed in more than one way, includ
ing attending the original planning meetings, preparing the first draft, comment
ing and contributing sections, corrections, or references, participating in a final
review meeting, critiquing and evaluating the individual chapters, and finally
reviewing and proofing the entire volume.
Our principal collaborators, listed alphabetically by their names and affilia
tions, are as follows:
R. Arredondo, E.D. 1. Fisher, M.D.
Texas Tech University Medical University of South Carolina
Lubbock, Texas Charleston, South Carolina
M. Bean, M.D. M. Galanter, M.D.
Harvard Medical School Albert Einstein College of Medicine
Cambridge, Massachusetts Bronx, New York
S. B. Blume, M.D. D. Gallant, M.D.
National Council on Alcoholism Tulane University School of Medicine
New York, New York New Orleans, Louisiana
P. Bourne, M.D. P. K. Gessner, Ph.D.
Global Waters State University of New York
Washington, D.C. Buffalo, New York
1. Chappel, M.D. 1. B. Griffin, M.D.
University of Nevada Emory University School of Medicine
Reno, Nevada Atlanta, Georgia
v
vi Acknowledgments
1. Kincannon, Ph.D. S. Schnoll, M.D., Ph.D.
University of Minnesota Northwestern University
Minneapolis, Minnesota Chicago, Illinois
R. S. Krug, Ph.D. E. Senay, M.D.
University of Oklahoma University of Chicago
Oklahoma City, Oklahoma Chicago, Illinois
G. Litman, Ph.D. C. Suwanwela, M.D.
Institute of Psychiatry Chulalongkorn University
London, England Bangkok, Thailand
J. Morgan, M.D., Ph.D.
F. Tennant, M.D., D.P.H.
City College of New York
Community Health Projects, Inc.
New York, New York
West Covina, California
R. Niven, M.D.
National Institute of Alcohol Abuse and A. Uchtenhagen, M.D.
Alcoholism University of Zurich
Rockville, Maryland Zurich, Switzerland
A. Pokorny, M.D. R. L. Weddige, M.D.
Baylor College of Medicine Texas Tech University School of Medicine
Houston, Texas Lubbock, Texas
Others who contributed collaborative expertise in the original planning or
writing, offered critical comments, or participated directly in the rewriting pro
cess are listed alphabetically by their names and affiliations as follows:
T. Baasher, M.D. E. M. Corrigan, D.S.W.
World Health Organization Rutgers University
Alexandria, Egypt New Brunswick, New Jersey
B. G. Burton Bradley, M.D. M. Gerald, Ph.D.
Mental Health Services Ohio State University
Papua, New Guinea Columbus, Ohio
J. Calahan, Ph.D.
H. Ghodse, M.D.
National Institutes of Drug Abuse
S!. George's Hospital
Rockville, Maryland
London, England
J. Chi'en, M.S.W.
M. Grant, Ph.D.
Society for the Aid and Rehabilitation of Drug
The Maudsley Hospital
Abusers
London, England
Hong Kong
S. Cohen, M.D. Z. Hasan, M.D.
University of California Jenah Postgraduate Medical Center
Los Angeles, California Karachi, Pakistan
J. Cooper, M.D. D. Hawkes, Ph.D.
National Institute of Drug Abuse Whitchurch Hospital
Rockville, Maryland Whitchurch, Cardiff, Wales, United Kingdom
Acknowledgments vii
E. Heinemann, M.A. FAAN E. D. Nelson, Pharm. D.
University of Washington University of Cincinnati
Seattle, Washington Cincinnati, Ohio
V. Hudolin, M.D.
P. O'Gorman, Ph.D.
Dr. Mladen Stojanovic University Hospital
Berkshire Farm Center and Services for Youth
Zagreb, Vinogradska, Yugoslavia
Canaan, New York
J. Hughes, M.D.
E. M. Pattison, M.D.
University of Vermont
Medical College of Georgia
Burlington, Vermont
Augusta, Georgia
P. Hughes, M.D.
Veterans Administration Medical Center R. E. Popham, M.D.
Bay Pines, Florida Addiction Research Foundation
Toronto, Ontario, Canada
F. Iber, M.D.
University of Maryland Hospital N. Sartorius, M.D.
Veterans Administration Medical Center World Health Organization
Baltimore, Maryland Geneva, Switzerland
W. Jilek, M.D.
R. Segal, Pharm. D.
University of British Columbia
Addiction Research Foundation
Vancouver, British Columbia, Canada
Toronto, Ontario, Canada
L. Jilek-Aall, M.D.
University of British Columbia H. Sell, M.D.
Vancouver, British Columbia, Canada World Health Organization
New Delhi, India
E. Larkin, M.D.
Addiction Research Foundation J. Severinghaus, M.D.
Toronto, Ontario, Canada Dartmouth Medical School
Veterans Administration Hospital
J. Makanjola, M.D.
White River Junction, Vermont
ARO Neuropsychiatric Hospital
Abeokuta, Ogun State, Nigeria A. Showanasai, M.D.
Phra Mongkutlao Army General Hospital
G. Martin, M.D.
Bangkok, Thailand
Addiction Research Foundation
Toronto, Ontario, Canada
R. Smart, Ph.D.
R. Masaroni, M.D. Addiction Research Foundation
World Health Organization Toronto, Ontario, Canada
Geneva, Switzerland
M. I. Soueif, M.D.
D. Mohan, M.D. Cairo, Egypt
All India Institute of Medical Sciences
New Delhi, India S. Sparber, Ph.D.
University of Minnesota
M. H. Mubbasher, M.D., D.P.M.
Minneapolis, Minnesota
Rawalpindi, Pakistan
C. A. Naranjo, M.D. J. T. Ungeleider, M.D.
Addiction Research Foundation University of California
Toronto, Ontario, Canada Los Angeles, California
J. C. Negrete, M.D. A. Zweben, M.D.
Montreal General Hospital Addiction Research Foundation
Montreal, Quebec, Canada Toronto, Ontario, Canada
viii Acknowledgments
Finally, we thank most graciously our final reviewers, who read and cri
tiqued the entire book prior to publishing:
S. Blume, M.D. A. Pokorny, M.D.
National Council on Alcoholism Baylor College of Medicine
New York, New York Houston, Texas
J. Fisher, M.D. F. Seixas, M.D.
Medical University of South Carolina Harvard Medical School
Charleston, South Carolina Belmont, Massachusetts
J. F. Maddux, M.D.
University of Texas Health Science Center
San Antonio, Texas
Several WHO Collaborating Centers have also participated in the develop
ment of this volume, as follows:
Addiction Research Foundation Institute of Psychiatry
Toronto, Ontario, Canada Mexico City, Mexico
Drug Dependence Research Center National Institute of Alcohol Abuse and
Universiti Sains Alcoholism
Penang, Malaysia Rockville, Maryland
Health Research Institute National Institute of Drug Abuse
Bangkok, Thailand Rockville, Maryland
Numerous others have provided critical assistance at many points along the
way in the development of this manual, These include colleagues who have
commented and assisted on technical points, medical educators and educators in
other fields (nursing, social work, psychology, public health), house officers,
residents, and medical students. We cannot cite each of them by name, but wish
to acknowledge the value of their efforts.
A. Arif, M.D.
Geneva, Switzerland
J. Westermeyer, M.D., Ph.D.
Minneapolis. Minnesota
Foreword
During the last few centuries, and particularly in recent decades, problems result
ing from the excessive use of drugs and alcohol have spread virtually as an
epidemic to every country in the world and to almost every community. Abuse of
alcohol and drugs is related to numerous other health problems, such as the
spread of acquired immune deficiency syndrome (AIDS) on all continents.
Health and social services today cannot afford to ignore this crisis since it affects
all levels of society and manifests itself in diverse health and social problems.
In recent years, the World Health Organization has received numerous
requests for training material for physicians in this field. This manual therefore
meets an urgent need. The availability of new data and the dearth of suitable
textbooks have made its preparation mandatory.
The influence of sociocultural factors on drug dependence and alcohol
related problems-on their cause, development, and consequences as well as on
their treatment and prevention-has been taken into account in the preparation of
this manual in order to ensure that its usefulness is not limited to one country or
region. It has been prepared primarily for the teaching of physicians and medical
students, although much of it is relevant to the training of nurses, midwives,
health educators, primary-care workers, medical social workers, counselors, and
psychologists. In fact, suggestions have been included for adapting the manual
for use in the training of such varied groups of students. An entire chapter has
been devoted to providing guidelines for the training of clinicians in drug
alcohol dependence, paying particular attention to the clinician's attitude toward
the patient.
ix
x Foreword
The authors are to be commended for the preparation of this valuable guide
for health workers in combating this major health problem.
Dr. T. A. Lambo
Deputy Director-General
World Health Organization
Geneva, Switzerland
Contents
1. Introduction and Definitions ............................ 1
1. Background.......................................... 1
2. Organization and Structure of the Manual ................. 2
3. Purpose and Aim ..................................... 3
4. Methodology-How Was This Manual Produced? .......... 3
5. Special Aspects of This Volume ......................... 4
6. Definitions and Tenninology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
I. TEACHING APPROACHES ................................ 7
2. Guidelines for Teaching and Training ................... 9
1. Introduction.......................................... 9
2. Curriculum Design. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1. Statement of the Problem: Sociomedical Crisis Today .. 9
2.2. Approaches to Curriculum Design .................. 10
2.3. Problems in Curriculum Development. . . . . . . . . . . . . . . 12
3. Curriculum Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1. Instructional Tasks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2. Faculty and Students ............................. 15
3.3. Course Content ................................. 16
xi