Table Of Content

01_484830 ffirs.qxd 1/11/05 11:36 AM Page i Treating Drug Problems 01_484830 ffirs.qxd 1/11/05 11:36 AM Page ii Wiley Series on Treating Addiction Series editors, Robert Holman Coombs and William A. Howatt TREATINGDRUGPROBLEMS Arthur W. Blume TREATINGALCOHOLPROBLEMS Frederick Rotgers TREATINGGAMBLINGPROBLEMS William G. McCown 01_484830 ffirs.qxd 1/11/05 11:36 AM Page iii Treating Drug Problems Arthur W. Blume 01_484830 ffirs.qxd 1/11/05 11:36 AM Page iv This book is printed on acid-free paper. ∞ Copyright © 2005 by John Wiley & Sons. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. 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ISBN: 0-471-48483-0 Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 01_484830 ffirs.qxd 1/11/05 11:36 AM Page v To Karen, Amanda, and Rachel, who each in her own way has taught me valuable lessons about love, life, compassion, and change. 01_484830 ffirs.qxd 1/11/05 11:36 AM Page vi 02_484830 ftoc.qxd 1/11/05 11:37 AM Page vii CONTENTS Series Preface xv Preface xvii Acknowledgments xix Chapter 1: Drug Problems: An Overview Prevalence of Drug Abuse 2 What Exactly Is a Drug Problem? 5 The Three C’s 5 Compulsive Use 6 Loss of Control 8 Continued Use in Spite of Consequences 10 Myths Versus Facts Concerning Drug Problems 11 Patterns to Drug Problems 15 Transient Versus Chronic Problems 15 Dependence Versus Abuse 16 Psychological Versus Physical Dependence 18 Spontaneous Remission and Maturing Out 18 Clinical Versus Nonclinical Populations: Why Some Do Not Mature Out 19 Progression 20 Drug Problems: A Biopsychosocial Model 21 Biological Risk Factors 22 Environmental Risk Factors 22 Behavioral Risk Factors 25 Cognitive Risk Factors 27 Cognitive Problems Related to Substance Abuse 29 Emotional Risk Factors 30 vii 02_484830 ftoc.qxd 1/11/05 11:37 AM Page viii viii CONTENTS Epidemiology of Certain At-Risk Populations 36 Influences of Age and Gender 37 Familial Considerations 39 Treatment Success/Failure 40 Recovery/Relapse Rates 42 The Unrecognized Treatment: Prevention Programs 42 What the Future Holds: What Is Next for Treatment? 44 Summing Up 45 Key Terms 46 Recommended Reading 46 Chapter 2: Recognizing a Drug Problem Symptoms of a Drug Problem: What Family, Friends, and Coworkers May Observe 51 Signs of a Drug Problem: What Professionals May Observe 55 When Collaterals Come for Help First 58 Recognizing the Existence of More Than One Problem 59 Co-occurring Mental Health Symptoms 60 Co-occurring Physical Health Symptoms 67 When Professionals May Be Impaired 68 How Attitudes Influence Drug Problems 69 Professional Collaboration 72 Professional Obligations to Intervene 74 Obligations Toward Other Professionals 76 Professional Referrals 78 Summing Up 87 Key Terms 87 Recommended Reading 88 Chapter 3: Utilizing Optimal Professional Resources Developing a Professional Network 90 Matching Clients to Therapists 94 02_484830 ftoc.qxd 1/11/05 11:37 AM Page ix Contents ix Referral Dos and Don’ts 95 Motivating Change 96 Motivational Strategies 98 Motivational Interviewing 103 The Transtheoretical Model 106 Overcoming Client Obstacles 110 Overcoming Therapist Obstacles 118 Preventing and Dealing With Crises 123 Aggression and Anger 123 Suicidal Behavior 124 Psychiatric Decomposition 129 Risk Management Strategies 132 Summing Up 133 Key Terms 133 Recommended Reading 134 Chapter 4: Developing an Effective Treatment Plan Intake Interview 137 Treatment Planning 139 Prioritizing Items on the Treatment Plan 143 The Importance of Assessment in Treatment 146 Assessing History and Diagnosis 146 Assessing Substance Use Patterns, Consequences, and Contexts 152 Assessing Client Potential for Behavior Change 155 Assessing Cognitive Function 158 Assessing Psychiatric Symptoms 160 Assessing Interpersonal Relations 162 Assessment as Intervention 162 Problems With Assessment Across Cultures 163 Involving Family and Friends in Treatment 166 Assessing Progress 170 Summing Up 175 Key Terms 176 Recommended Reading 176