Seminars in addiction psychiatry

311 Pages·2021·6.355 MB·English

by  Ed Day (editor)

Seminars in Addiction
Psychiatry
College Seminars Series
FordetailsofavailableandforthcomingbooksintheCollegeSeminarsSeriespleasevisit:
www.cambridge.org/series/college-seminars-series.
Seminars in Addiction
Psychiatry
Second edition
Edited by
Ed Day
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Firstpublished1994,asSeminarsinAlcoholandDrugMisusebyTheRoyalCollegeofPsychiatrists
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Contents
ListofContributors vi
Preface ix
1 HistoricalandConceptual 9 ComorbidSubstanceUseand
ApproachestoAddiction 1 MentalIllness 163
EdDayandJamesMorris MichaelKelleherandLukeMitcheson
2 IllicitDrugUse:Epidemiology, 10 MedicalAspectsofDrugandAlcohol
AetiologyandPrevention 15 Use 175
EdDay DavidPangandMarkPucci
3 IllicitDrugUse:ClinicalFeaturesand 11 OrganisingTreatmentServicesfor
Treatment 42 DrugandAlcoholMisusers 196
EdDay EmilyFinch
4 AddictiontoPrescription 12 TobaccoUseDisorders 207
Medication:Benzodiazepines, DebbieRobsonandAnnMcNeill
Z-DrugsandGabapentinoids 68
13 NovelPsychoactiveSubstancesand
EmmaRourkeandFergusLaw
ClubDrugs 230
5 AlcoholUseDisorders: DimaAbdulrahimandOwenBowden-
EpidemiologyandPrevention 97 Jones
PaulBogowicz,EilishGilvarry,Andrea
14 AddictionProblemsinaFamilyand
HearnandEileenKaner
SocialContext 252
6 AlcoholUseDisorders:Aetiology AlexCopelloandEdDay
andPathophysiology 111
15 AddictionRecoveryMutual-Aid
NicolaJ.KalkandMaryThornton
Organisations 266
7 AlcoholUseDisorders:Clinical JohnF.Kelly,AlexandraAbryand
FeaturesandTreatment 128 BrandonG.Bergman
DuncanRaistrickandGillianTober
8 PsychologicalApproachesto
Addiction 147
RobHillandJenniferHarris Index 280
v
Contributors
DimaAbdulrahim EdDay
NEPTUNEProjectPrincipalResearcher& ClinicalReaderinAddictionPsychiatry,
ProgramManager,CentralNorthWest InstituteforMentalHealth,Schoolof
LondonNHSFoundationTrust Psychology,UniversityofBirmingham&
ConsultantinAddictionPsychiatry,
AlexandraAbry
SolihullIntegratedAddictionService,
SeniorClinicalResearchCoordinator, InstituteforMentalHealth,Schoolof
RecoveryResearchInstitute,Centerfor Psychology,52PritchattsRoad,Edgbaston,
AddictionMedicine,Massachusetts BirminghamB152TT
GeneralHospital,andHarvardMedical
School,151MerrimacStreet,6thFloor, EmilyFinch
Boston,MA02114. ConsultantinAddictionPsychiatry,
Southwark,CentralAcuteandAddictions
BrandonG.Bergman
Directorate,SouthLondonandMaudsley
AssistantProfessorofPsychology,Harvard NHSFoundationTrust,MarinaHouse,63-
MedicalSchool,RecoveryResearch 65DenmarkHill,LondonSE58RS
Institute,CenterforAddictionMedicine,
MassachusettsGeneralHospital,and EilishGilvarry
HarvardMedicalSchool,151 ProfessorandConsultantinAddiction
MerrimacStreet,6thFloor,Boston,MA Psychiatry,NewcastleTreatmentand
02114. Recovery(NTaR),PlummerCourt,Carliol
Place,NewcastleNE16UR
PaulBogowicz
CT3inPsychiatry,UniversalCrisisTeam JenniferHarris
Northumberland/NorthTyneside, ConsultantClinicalPsychologist,Wiltshire
Cumbria,Northumberland,Tyneand PsychologicalService,AvonandWiltshire
WearNHSFoundationTrust,StGeorge’s NHSMentalHealthPartnershipNHSTrust
Park,MorpethNE612NU
AndreaHearn
OwenBowden-Jones ConsultantinAddictionPsychiatry,
ConsultantinAddictionPsychiatry, NewcastleTreatmentandRecovery
CentralNorthWestLondonNHS (NTaR),PlummerCourt,CarliolPlace,
FoundationTrust,ClubDrugClinic,69 NewcastleNE16UR
WarwickRoad,EarlsCourtLondon
RobHill
SW59HB
ConsultantClinicalPsychologistand
AlexCopello HonoraryVisitingResearchFellow,South
ProfessorofAddictionsandConsultant LondonandtheMaudsleyNHS
ClinicalPsychologist,Institutefor FoundationTrust,63–65DenmarkHill,
MentalHealth,SchoolofPsychology,52 LondonSE58RZandtheInstituteof
PritchattsRoad,Edgbaston,Birmingham Psychiatry,Psychology&Neuroscience,
B152TT King’sCollegeLondon
vi
ListofContributors vii
NicolaJ.Kalk JamesMorris
ConsultantPsychiatristinAddictionsand ProgrammeManager,AlcoholandDrugs,
VisitingClinicalLecturer,SouthLondon TreatmentandRecoveryTeam,Public
andtheMaudsleyNHSFoundationTrust& HealthEngland
King'sCollegeLondon
DavidPang
EileenKaner ConsultantinAddictionPsychiatry,
ProfessorofPrimaryCare&PublicHealth CGLCentral&WestHub,255Hospital
Research,PopulationHealthSciences Street,Birmingham,WestMidlands
Institute,FacultyofMedicalSciences, B192YF
NewcastleUniversity,Baddiley-Clark
MarkPucci
Building,RichardsonRoad,Newcastle
uponTyneNE24AX ConsultantinAcuteMedicine,Clinical
PharmacologyandTherapeutics,Queen
MichaelKelleher ElizabethHospital,UniversityHospitals
ConsultantAddictionsPsychiatristand BirminghamNHSFoundationTrust
ClinicalLeadforLambethAddictions,
LambethAddictionsConsortium,12–14 DuncanRaistrick
BrightonTerrace,Brixton,London ConsultantAddictionPsychiatrist&
SW98DG VisitingSeniorLecturer,TheUniversityof
Leeds
JohnF.Kelly
DebbieRobson
ElizabethR.SpallinProfessorofPsychiatry
intheFieldofAddictionMedicineat SeniorResearchFellow,National
HarvardMedicalSchool,Recovery AddictionsCentre,InstituteofPsychiatry,
ResearchInstitute,CenterforAddiction Psychology&Neuroscience,King’sCollege
Medicine,MassachusettsGeneralHospital, London,4WindsorWalk,DenmarkHill,
andHarvardMedicalSchool,151 LondonSE58BB
MerrimacStreet,6thFloor,Boston,MA
EmmaRourke
02114.
GPRegistrar,GloucestershireHospitals
FergusLaw NHSFoundationTrust,GreatWestern
HonorarySeniorClinicalLecturer,Faculty Road,GloucesterGL13NN
ofHealthSciences,UniversityofBristol,
MaryThornton
TyndallAvenue,BristolBS81TH
CoreTrainee3andHonoraryClinical
AnnMcNeill ResearchFellow,SouthLondonandthe
ProfessorofTobaccoAddiction,National MaudsleyNHSFoundationTrust&King’s
AddictionsCentre,InstituteofPsychiatry, CollegeLondon
Psychology&Neuroscience,King’sCollege
GillianTober
London,4WindsorWalk,DenmarkHill,
ConsultantAddictionPsychologist&
LondonSE58BB
VisitingSebiorLecturer,TheUniversityof
LukeMitcheson Leeds

Preface
As a psychiatry trainee in the late 1990s I looked to the College Seminars Series as a vital
source of information,bothto pass college membership exams but alsoto go beyondthe
facts that standard textbooks provided. Here was a series written by people who were
applying textbook knowledge at the ‘coalface’ of clinical practice. Reflecting my growing
interest in the field, I found Seminars in Alcohol and Drug Misuse especially useful. I was
particularlyfascinatedbytheopeningchapter,whichoutlinedtheevolutionoftheconcept
ofdependence.RereadingthatchapterwhenconsideringthisbookIwassurprised tosee
referencetoDSM-III-R,whichremindedmethatthelasteditionofthebookwaspublished
in 1994. This new edition retains the core structure of the first edition, with revised
and updated versions of each of the original book’s 11 chapters written by new authors.
In Chapter 1, the new edition reflects the changes in the diagnostic landscape that have
occurred in the intervening quarter century. While ICD-11 has simplified the concept of
dependence, DSM-5 has abandoned it altogether, leaving us with a potentially confusing
differenceinvariouspartsoftheworld.Chapter1setsthesceneforthebookbyreviewing
the diagnostic issues that we consider when we think of ‘addiction’, and reviewing the
historicalpathtoourpresentunderstandingofthisterm.
Thecoreworkofthespecialistaddictionpsychiatristremainsthetreatmentofheroin,
cocaine(Chapters2and3)andalcoholdependence(Chapters5,6and7).Thesetopicsare
explored over the five chapters, covering epidemiology, aetiology, prevention and treat-
ment. The prevalence of drug use has ebbed and flowed since the first edition, and our
understanding of the aetiology of addiction has expanded. Large-scale epidemiological
analysis has promoted a concept of risk and protective factors for developing a drug use
disorder.Hugeadvancesintheunderstandingoftheneurobiologyofaddictionarereflected
inbothChapters2and6.Preventionandtreatmentstrategieshavealsomovedforwards,
with the development since 1994 of a significant evidence base for take-home naloxone,
opioid agonist treatment with buprenorphine and recovery-orientated systems of care.
Prescriptionmedicationaddictionhasalsoincreasedinsignificance,withnewdrugssuch
asthegabapentinoidsnowmeritingconsideration(Chapter4).
Psychological approaches remain the mainstay of treatment, and the developments in
this area are captured in Chapter 8. Motivational interviewing has become an important
strategyinthefield,anditisaskillthatallhealthcareprofessionalsshouldbeabletouse.
Comorbidityofaddictionandmentalillnessremainsascommonandasproblematicasit
did 25 years ago, and Chapter 9 covers the latest policy responses to the issue in the UK.
Physicalhealthproblemsresultingfromdrugoralcoholusearestillaspotentiallyseriousas
they were, but advances in medical knowledge mean that there is more hope of effective
treatment(e.g.hepatitisCinfection),assummarisedinChapter10.Theperiodfrom2001to
2008sawrapiddevelopmentofbothevidencebaseandtreatmentservicesintheUK,only
formuchofthelattertowitherawayinthefollowingdecade.Thisisreflectedinthechapter
on treatment service provision (Chapter 11), reminding us that addiction remains
astigmatisedissueandthatitstreatmentissubjecttopoliticalideology.
This book includes four new chapters not present in the first edition, three covering
long-standing issues and one a completely new one. Nicotine has long been the most
ix