Alcohol and Tobacco

Medical and Sociological Aspects of Use, Abuse and Addiction
2011
ISBN: 978-3-7091-1718-7
Verlag: Springer Vienna

Buch, Englisch, 354 Seiten, Paperback, Format (B × H): 170 mm x 244 mm, Gewicht: 648 g

Alcohol and nicotine addiction mostly occur together. Over the last ten years therapeutic aspects and motivational strategies have been considerably improved. Hence, groups and subgroups have been defined and can be treated with specific medication and tailor-made psychotherapies, leading in the long term to considerably better and more effective results than the once broadly applied, rigorous abstinence -based therapies. However, alcohol and nicotine addiction still represent major medical and social problems.In this book, new therapeutic approaches are comprehensively described, outlining the different interactions between personality, environment and the effects of the substance.In addition to prevention-based therapies and diagnosis, essential psychological and sociological strategies, as well as medication-based therapies, are also presented in detail. All of these therapies have realistic aims and are of global validity. In addition, the book provides a broad overview of the American and European epidemiology of alcohol and nicotine addictions. The book is written for all those who care for and offer professional therapy for alcohol and nicotine-addicted patients.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Hesselbrock, Michie

Lesch, Otto-Michael

Hesselbrock, Victor

Walter, Henriette

Wetschka, Christian

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Verhaltenstherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Allgemeinmedizin, Familienmedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Inhaltsverzeichnis

1 Information on the origination of the book1.1   Aims of this book1.2   Personal reasons for the first author writing this book 2 Addiction- a short overview over a widespread disease2.1 Introduction2.2 Prevention2.3 Diagnosis of addiction2.4 Aetiology of addiction2.5 Secondary disorders and addiction2.6 Secondary diseases and brain functions2.7 Subgroups of addicts2.8 Motivation of addicts2.9 The path from motivation to therapy2.10 Addiction and relapse2.11 Specific groups of addicts       2.11.1 Co-morbidity of tobacco and alcohol addiction       2.11.2 Overweight, eating disorders       2.11.3 Gender2.12 Addiction and the homeless2.13 Polytoxicomania2.14 Non-substance dependence 3   Aetiology of Addiction3.1 The psycho-socio-biological model3.2 Psychological theories       3.2.1 Behavioural approaches       3.2.2. Models of depth psychology       3.2.3 Depth psychological approach       3.2.4 Ego-psychological approaches       3.2.5 The psychological model of object relations       3.2.6 Approach according to theories of Narcissism        3.2.7 Explanation models according to family psychotherapy 3.3 Social explanation approaches3.4 Biological theories about the aetiology of tobacco and alcohol addiction       3.4.1 Important findings about tobacco and alcohol use from basic research        3.4.2 Aspects of alcohol and tobacco metabolism       3.4.3 Maternal tobacco and alcohol use during pregnancy - a risk factor for the offspring?                 3.4.3.1      Smoking during pregnancy                 3.4.3.2      Alcohol use during pregnancy3.5 Aetiological aspects of tobacco and alcohol addiction from an epidemiological perspective3.6 Aetiology of addiction from a psychiatric perspective 4 Prevention strategies 4.1 Attitude towards addictive drugs       4.1.1 Attitudes towards alcohol consumption       4.1.2 Attitudes towards tobacco consumption4.2 Primary prevention of tobacco and alcohol addiction4.3 Secondary prevention: early diagnosis and early intervention4.3.1 Conclusions for secondary prevention          4.3.1.1 Measures concerning the addictive drug          4.3.1.2 Measures for enabling adolescents to live drug-free 4.4 Tertiary prevention 5 Diagnosis of abuse and addiction 5.1 Problems concerning psychiatric diagnoses5.2 Development of the term “addiction”5.3 Substance related diagnoses in the ICD-10       5.3.1 Harmful use (ICD-10 F10.1, F17.1)       5.3.2 Dependence syndrome (ICD-10 F10.2, F17.2)       5.3.3 Withdrawal state (ICD-10: F10.3)5.4 Substance related diagnosis in DSM-IV (American Psychiatric Association. 1994)       5.4.1 DSM-IV and the multidimensional diagnostic in five axes       5.4.2 Diagnosis according to DSM-IV axis I                      5.4.2.1 Tobacco or alcohol abuse                      5.4.2.2 Tobacco and alcohol addiction        5.4.3 Specifiers defining subgroups of dependence                         5.4.3.1 Tolerance and withdrawl                        5.4.3.2 Course specifiers        5.4.4 Therapeutic appraoch         5.4.5 Withdrawal symptoms of tobacco and alcohol 5.5 Commonalities and differences of ICD-10 and DSM-IV5.6 Implication of these classification systems for therapy and research      5.6.1 Alcohol            5.6.1.1. Studies on medicamentous relapse prophylaxis (according to Hester RK and                          Miller WR 2003)            5. 6.1.2 Studies on relapse prophylaxis using psychotherapy            5. 6.1.3 Family psychotherapy      5.6.2 Tobacco 6 Types, dimensions and aetiology6.1 Alcohol addiction       6.1.1 Development of typology research       6.1.2 Important types for research and practice              6.1.2.1 Two-cluster solutions            6.1.2.2 The four-cluster solutions       6.1.3 Assessment of severity in different dimensions                 6.1.3.1 Addiction Severity Index (ASI)                 6.1.3.2 Syndrome diagnosis according to Scholz 6.2 Tobacco addiction      6.2.1 Smoking typology according to Schoberberger and Kunze       6.2.2 Smoking typology according to Fagerstroem       6.2.2 European Smoking Classification System 6.3 Alcohol addiction: Lesch’s typology       6.3.1 Framework for the definition of Lesch’s typology       6.3.2 Alcohol addiction from a longitudinal perspective 1976-1982-1995       6.3.3 The “Burgenland Model”       6.3.4 Methodology of the longitudinal study on alcohol dependence (according to DSM-III                    and ICD-9), used in the development of Lesch’s typology        6.3.5 Stability in the longitudinal course         6.3.6 The four long-term illness courses used in Lesch’s typology        6.3.7 Results from studies using the Lesch typology                   6.3.7.1 Studies on prognosis                    6.3.7.2 Studies on biology and genetics                   6.3.7.3 Relapse prophylaxis studies, anti-craving substances                   6.3.7.4 Other results relating to Lesch’s typology         6.3.8 Lesch’s typology from an international comparative perspective 6.4 The relationship between alcohol dependent patients according to Lesch`s typology and the     severity of tobacco addiction7 Motives for alcohol and/or tobacco addicted patients to seek medical help 7.1 Tobacco addiction7.2 Alcohol addiction7.3 Sequelae that bring patients into therapy       7.3.1 Tobacco and sequelae                 7.3.1.1 Introduction                7.3.1.2 Tobacco and neurology                7.3.1.3 Tobacco and internal medicine                        7.3.1.3 1Heart disease and circulatory disorders                        7.3.1.3 2 Pulmonary diseases                7.3.1.4 Oncological diseases                7.3.1.5 Dentistry                 7.3.1.6 Psychiatry          7.3.2 Alcohol and sequelae              7.3.2.1 Introduction              7.3.2.2. Alcohol´s significance for neurology and psychiatry               7.3.2.3 Alcohol and psychiatric disorders                                    7.3.2.3.1 Alcohol and affective disorders                        7.3.2.3.2 Alcohol and anxiety             7.3.2.4 Alcohol and neurological disorders              7.3.2.5 Alcohol and internal medicine                  7.3.2.5.1 Gastroenterology                  7.3.2.5.2 Cardiovascular system                         7.3.2.5.2.1 Alcoholic cardiomyopathy                          7.3.2.5.2.2 Cardiac arrhythmia, “Holiday-Heart-Syndrome” and sudden cardiac                                    arrest                         7.3.2.5.2.3 Coronary heart disease and myocardial infarct                          7.3.2.5.2.4 Hypertonia                        7.3.2.5.2.5. Hypotheses on the aetiology of alcohol addiction and heart diseases                         7.3.2.5.2.6 Alcohol typology according to Lesch: homocysteine levels and heart disease                          7.3.2.5.3. Oncological diseases                7.3.2.6. Alcohol and medication for sequelae 8 Detection of alcohol and tobacco addiction 8.1 Recommendations for the first contact8.2 Assessment of drinking behaviour using biological markers       8.2.1 Trait markers        8.2.2 State markers        8.2.3 Associated markers        8.2.4 Practical suggestions for the use of biological markers for forensic purposes                8.2.4.1 Blood alcohol measurement                 8.2.4.2 Blood alcohol concentration (BAC)               8.2.4.3 Widmark Formula                8.2.4.4 Breath alcohol             8.2.4.5 Products of alcohol metabolism                          8.2.4.5.1 Ethylglucuronide                        8.2.4.5.2 %CDT (Carbohydrate-deficient-transferrin)       8.3 The clinical dialogue in tobacco addiction  9 Therapeutic strategies for alcohol and tobacco dependence9.1 Motivation for therapy in different settings             9.1.2 Motivational interviewing at the general practitioner’s            9.1.3 Motivational interviewing in internal medicine             9.1.4. Motivational interviewing during pregnancy             9.1.5. Motivational interviewing in psychiatric settings 9.2 Pharmacotherapy of alcohol and tobacco dependence                 9.2.1 Alcohol dependence                9.2.2 Tobacco dependence 9.3 Pharmacotherapy of alcohol withdrawal                  9.3.1 Withdrawal syndrome                  9.3.2 Therapy of withdrawal states                 9.3.3 Therapy of withdrawal syndromes according to Lesch’s typology                         9.3.3.1 Management of detoxification in type I alcohol dependents                        9.3.3.2 Management of detoxification in type II alcohol dependents                         9.3.3.3 Management of detoxification in type III alcohol dependents                        9.3.3.4 Management of withdrawal in type IV dependents                 9.3.4 Complications during alcohol withdrawal                           9.3.4.1 Withdrawal seizures (Grand Mal)                          9.3.4. 2 Delirant and associated states (Meta-alcoholic psychosis) 9.4 Alternatives to withdrawal                9.4.1 Gradual reduction of drinking: “Cut down drinking” method,                                      according to David Sinclair                                      9.4.2 Case study: “Cut down drinking” 9.5  Pharmacotherapy of the tobacco withdrawal syndrome                 9.5.1 Symptoms of the tobacco withdrawal syndrome                 9.5.2 Therapy of the tobacco withdrawal syndrome                          9.5.2.1. Withdrawal therapy of tobacco dependency with Fagerstroem = 5                        9.5.2.2. Withdrawal therapy of tobacco dependency with Fagerstroem = 4 9.6 Medical strategies for relapse prophylaxis                  9.6.1 General guidelines for relapse prophylaxis                 9.6.2 Goals for relapse prophylaxis                 9.6.3 Medication against so-called “positive” craving (= desire for pleasurable,                                       rewarding effects of the addictive substance)                        9.6.3.1 Alcohol                        9.6.3.2 Tobacco                9.6.4 Pharmacotherapy against so called “negative” craving (= desire for addictive                                           substances to relieve negative mood and anxiety)                         9.6.4.1 Alcohol                         9.6.4.2 Tobacco                9.6.5 Pharmacotherapy of relapse prevention in alcohol dependence                         9.6.5.1 Alcohol                        9.6.5.2 Tobacco            9.6.6  Relapse prevention according to Lesch’s typology                          9.6.6.1 Relaps prevention in Lesch’s type I                        9.6.6.2 Relaps prevention in Lesch’s type II                        9.6.6.3 Relaps prevention in Lesch’s type III                        9.6.6.4 Relaps prevention in Lesch’s type IV            9.6.7 Treatment of relapse according to Lesch’s typology               9.6.8 Pharmacotherapy of relapse prophylaxis in tobacco dependents                         9.6.8.1 Medication for relapse prevention of tobacco dependents                         9.6.8.1.1 Nicotine replacement therapy                                     9.6.8.1.2 Varenicline                         9.6.8.1.3 Anti-depressants                         9.6 8.1.4 Bupropion                         9.6.8.1.5 Nortriptyline                         9.6.8.1.6 Doxepin                         9.6.8.1.7 Clonidine                         9.6.8.1.8 Rimonabant                         9.6.8.1.9 Topiramate                9.6.8.2 Therapeutic procedures according to subgroups of nicotine dependent patients                        9.6.8.2.1 Subgroups according to Kunze and Schoberberger                        9.6.8.2.2 Craving in subgroups of tobacco dependent patients                9.6.8.3 Pharmacotherapy in the relapse prophylaxis of tobacco dependent patients according to                                   subgroups                          9.6.8.3.1 Relapse prophylaxis of cluster I                          9.6.8.3.2 Relapse prophylaxis of cluster II                                     9.6.8.3. 3 Relapse prophylaxis of cluster III                          9.6.8.3.4 Relapse prophylaxis of cluster IV                9.6.8.4    Medication of tobacco dependent patients in special situations                                       9.6.8.4.1 Nicotine consumption in combination with other dependencies and/or                                    other psychiatric disorders                            9.6.8.4.2 Tobacco dependence and pregnancy 10 Sociotherapy of alcohol and tobacco dependents with regards to Lesch’s typology10.1 Alcohol and tobacco10.2 The sociotherapeutic mission10.3 Classification Psychotherapy-Sociotherapy 10.4 Sociogenesis and sociotherapeutic chances        10.4.1 Primary, secondary and tertiary sociogenesis        10.4.2 Sociological factor on a macro level        10.4.3 Co-morbidity and marginal group identity         10.4.4 The link between social relationships (factors on a social macro level): group                        coherence and resilience         10.4.5 Analogy to Gerontology: the atrophy of the “social atom”10.5 Sociotherapy in the context of therapeutic phases        10.5.1 Sociotherapy location(s)        10.5.2 Therapeutic phases and settings10.6 State of the art: overlapping perspectives for sociotherapeutic housing and support          projects for alcohol dependents         10.6.1 Standard categories         10.6.2 Excursus: supported housing projects  - worlds of their own10.7 Motivation- a challenge for whom?        10.7.1 Ambivalent functions of motivation        10.7.2 Relationship between dependency and motivation systems10.8 Sociotherapy as a means of promoting networking        10.8.1 Micro and meso levels of networking        10.8.2 Macro levels of networking10.9 Sociotherapy with alcohol dependents in the context of Lesch’s typology          10.9.1 Critical relationship between psychiatry and sociotherapy          10.9.2 Application of the typology in sociotherapeutic contexts           10.9.2 Relationship between type and self-regulation          10.9.4 Therapeutic goals and strategies          10.9.5 Sociotherapeutic aspects of therapy with alcohol dependents, who are                               fundamentally impaired in their performance              10.9.5.1 Type IV characteristics           10.9.5.2 Cerebral damages as a result of chronic alcohol abuse, frontal lobe syndrome             10.9.5.3 Executive Cognitive Functioning           10.9.5.4 Coping with violence             10.9.5.5. Sociotherapeutic structures instead of psychotherapy             10.9.5.6 Stabilisation through social stimulation (SSS)              10.9.5.7 Compliance              10.9.5.8 Overview of pedagogic context variables               10.9.5.9 Over-challenge, “motivation”           10.9.5.10 Case studies of long-term abstinent type IV patients                          10.9.5.10.1 Norbert T., Type IV                           10.9.5.10.2 Peter N., Type IV                        10.9.5.10.3 Karl H., Type IV Appendix 1 Lesch Alcoholism Typology – QuestionnaireAppendix 2 Lesch European Smoker ClassificationIndexAbout the Authors

Über Autor(innen)

Otto Michael Lesch, MD is currently President of the Austrian Society of Addiction Medicine, Head of the Alcohol Research Group of the Medical University of Vienna, Department of Psychiatry and Psychotherapy. Since 1972 he is responsible for longterm studies in alcohol dependence. He organized many international clinical trials and basic research in alcohol and tobacco dependence. He served 12 years as secretary of ESBRA and organized European networks for alcohol research. He always bridged the gap between basic and clinical research and developed clinical used tools to define subgroups of addiction for better treatment approaches. His assessment tools are now available in many different languages (www.LAT-online.at).

 

Henriette Walter, MD, is University Professor at the Dept. of Psychiatry and Psychotherapy.  She is a member of the Senate and of many commissions of the Medical University, Vienna. Dr. Walter is working in the field of alcoholism since more than 20 years, both, practically and scientifically, with over 200 publications. She is secretary of the ‘AUSAM, the Austrian Society of Addiction Medicine and an ESBRA board member. She is associate editor of the Journal “Hypnose”, a field in which she takes an active scientific interest since 1982. With the “theory of frontalisation” as the neuro-equivalent for the hypnotic state, she contributed to the neuroimaging research in this field. She gives regular training courses in medical hypnosis.

 

Christian Wetschka, PhD.is socialpedagogue, working in diverse socialtherapeutic and pastoral fields, supervisor, founder of Verein Struktur, which provides commune-flats for alcohol dependent persons

 

Michie N Hesselbrock, PhD is Professor Emeritus at the School of Social Work, and Professor of Psychiatry at the School of Medicine, University of Connecticut.  She held the Zach’s Chair,  and was the founder and director of the PhD program at the School of Social Work before her retirement.   She has served on several NIH study sections and VA Merit review committees as a regular member and as an ad hoc reviewer.   Her research interests include epidemiology, behavior genetics, and health disparities of alcoholism and treatment

 

Victor Hesselbrock, PhD  is currently Professor and Interim Chairman, Department of Psychiatry, University of Connecticut School of Medicine.  He holds the Physicians Health Services endowed chair in Addiction Studies.  Dr. Hesselbrock is the Principal Investigator and Scientific Director of the University of Connecticut’s NIH/NIAAA funded Alcohol Research Center and is co-PI of the NIH funded national Collaborative Study on the Genetics of Alcoholism (COGA).  He is a past President of the Research Society on Alcoholism (RSA).  Dr. Hesselbrock is Associate Editor of Alcoholism: Clinical and Experimental Research, a Review Editor for Addiction, and a member of the editorial board of the Journal of Studies on Alcohol and Drugs.  His research interests include: the genetic epidemiology of alcoholism; co-morbid psychiatric conditions and substance dependence; and psychosocial, cognitive, and genetic risk factors for developing alcohol dependence and alcohol-related problems.