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Books by H. Thomas Milhorn
         
                                     


This book was written for primary  care physicians, who almost daily come into contact with substance dependent individuals and their families. However, it also should be helpful to primary care nurse practitioners and physician assistants, as well as medical students, primary care residents, emergency medicine physicians, ASAM and APA certified addictionists and those studying for certification in those specialties, psychiatrists, psychologists, and alcohol/drug counselors.

     Primary care physicians are in excellent positions to diagnose substance use disorders and to help the families of these patients get them into treatment. In addition, primary care physicians can detoxify patients as needed. On return from treatment, they can participate in the patientsí recovery programs to help prevent relapse.   
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Part I: The Basics

Chapter 1. Overview

The Problem

How Psychoactive Drugs differ from Other Drugs

Classification of Psychoactive Substances Based on their Effects on the Central Nervous System

Club Drugs and Date Rape Drugs

The Primitive Survival Brain Concept of Substance Dependence

Denial

Addicted versus Addict

Abstinence Syndromes

The Beginning of all 12 Step Programs

The Prescription Drug-dependent Patient

Addiction Medicine Specialists

DSM-5 Criteria for Substance Dependence

DEA Drug Schedules and Prescribing Regulations

 

Chapter 2. Substance Dependence Definitions

Biopsychosocial definition of Substance Dependence

Biological Factors

Psychological Factors

Sociological Factors

Disease Concept Definition of Substance Dependence

Genetic Studies

Natural Course of Alcoholism

The Disease Concept and the Primary Care Physician

AMAís Definition of Substance Dependence

ASAMís Definition of Substance Dependence

 

Chapter 3. Pharmacology of Psychoactive Substances

Pharmacodynamics

Receptors

Synapse

Reward Center of the Brain

Neurotransmitters Affected by Psychoactive Substances

Upregulation and Downregulation

Dose-response Relationships

Kindling

Pharmacokinetics

Route of Administration

Enzymatic Reactions

Steady State Relationships

Tolerance

Physical Dependence and Abstinence Syndrom

Set and Setting

 

Part II. Psychoactive Substance

Dependencies

 

Chapter 4. Alcohol Dependence

Forms of Alcoholic Beverages

Prevalence of Alcohol Use and Dependence    

Street Names for Alcohol

Pharmacology

Interaction of Alcohol with other Drugs

What Is Excessive Drinking?

Subtypes of Alcoholism    

Health risks

Health Benefits of Drinking Alcohol 

Evaluation of the Alcoholic

Tolerance

Dependence

Abstinence Syndrome

Ethanol Toxicity

Recovery

Other Alcohols

 

Chapter 5. Sedative-hypnotic Dependence

Barbiturates

Benzodiazepines

Z Drugs

Gamma hydroxybutyric Acid

Sedative-Hypnotics of Historical Interest

Meprobamate

Chloral Hydrate   

 

Chapter 6. Opioid Dependence

Prevalence of Use

The Opioids Drugs

Pharmacology

Opioid Agonists

Opioid Agonist-antagonists

Opioid Partial Agonists

Opioid Antagonists

Designer Drugs

Street Names

Health Risks

Tolerance

Dependence

Abstinence Syndrome

Opioid Overdose


Chapter 7. Stimulant Dependence

Prevalence of Use

The Amphetamines    

Cocaine

Methylphenidate
Phentermine

Modafinil

Bath Salts

Flakka

Caffeine

 

Chapter 8. Nicotine Dependence

Tobacco   

Cigarettes   

Factors That Influence Who Will Smoke Cigarettes

Health Risks

Benefits of Quitting Smoking

Electronic Cigarettes   

Cigars and Pipes

Smokeless Tobacco

Tolerance

Dependence

Abstinence Syndrome

Quitting Smoking

Nicotine Dependence Medications

Weight Gain
Relapse

Overdose

 

Chapter 9. Cannabis Dependence

Prevalence of Use

Marijuana

Cannabis Indica

Synthetic Cannabinoids

Hashish

Hash Oil

Tolerance

Dependence

Abstinence Syndrome

Toxicity

The Five Rules of Recovery      

Partial Recovery

Controlled Drinking

Drugs That May Be Hazardous to Recovery

Rational Use of Medications in Recovery

Support Groups

Web-Based Recovery Support


Chapter 10. Dissociative Drug Dependence

Phencyclidine (PCP)  

Ketamine    

Dextromethorphan

 

Chapter 11. Inhalant Dependence

Prevalence of Use

The Inhalant Drugs

Solvents and Aerosols        

Gases         

Alkyl Nitrites (Amyl Nitrite, Butyl Nitrite)

 

Chapter 12. Hallucinogen Dependence

Prevalence of Use

The Hallucinogens

Lysergamides

Phenylethylamines

Amphetamine-related hallucinogens

Other Hallucinogens

Street Names

Hallucinogen Persisting Perception Disorder

Tolerance, Dependence, and Abstinence Syndrome

Overdose  

 

Chapter 13. Anabolic Steroid Dependence

Prevalence of Use

The Anabolic Steroids   

Street Names

Pharmacology

Tolerance

Dependence

Abstinence Syndrome

Drugs used to Mask Anabolic Steroid Use

Alternatives to Anabolic Steroids

 

Part III: Diagnosis, Treatment, Recovery, Relapse, and the Family

 

Chapter 14. Diagnosis

Problems in Diagnosis

Making the Diagnosis

Screening Questionnaires

Personal and Family History

Patient Presentation

Physical Examination

Laboratory Tests

Drug Screening

Mixed Drug Dependencies

Presenting the Diagnosis 

Summary


Chapter 15. Treatment

History of Substance Dependence Treatment 

Getting the Addict into Treatment      

Treatment

Treatment Program Options

ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders

Support Groups

Inpatient Treatment

Outpatient Treatment

Therapeutic Communities and Halfway Houses

Support Groups as Primary Treatment

Aftercare 

Confidentiality 

The Primary Care Physician

 

Chapter 16. Recovery 

Recovery Dimensions

Tasks of Recovery        

The Recovery Process

Pharmacological Approaches

Alocohol Dependence

Opioid Dependence 

 

Chapter 17. Relapse

The Relapse Syndrome

Major Kinds and Stages of Relapse

Factors Contributing to Relapse

Preventing Relapse 

What to Do when Relapse Occurs 

Primary care Physicianís Role in Preventing Relapse

 

Chapter 18. The Family

The Healthy Family

The Addicted Family

Getting the Addict Sober

Getting the Family Well

The Family in Recovery

Adult Children of Alcoholics

 

Part IV. Special Groups

 

Chapter 19. Women

Gender Differences

Prevalence of Use

The Drugs    

Diagnosis

Treatment 

The Pregnant Addict 

The Fetus   

Breast Feeding

Aftercare

 

Chapter 20. Adolescents

The Normal Adolescent

The Substance Dependent Adolescent 

Denial 

Diagnosis

Getting the Adolescent into Treatment

Treatment   

Aftercare 

 

Chapter 21. The Elderly

Prevalence of Use

Pathophysiology of Aging   

The Elderly Addict

Diagnosis

Treatment

Evaluation   

Detoxification 

Rehabilitation 

Aftercare

 

Chapter 22. Other Groups

The Ethnic Minority Groups

American Indians/Alaska Natives

Asian/Pacific Islander

African Americans

Hispanic Americans

Co-occurring Disorder Patients

LGBT Patients

HIV Positive Patients

 

Chapter 23. The Impaired Physician

Prevalence of Use

Characteristics of the Impaired Physician

The Impaired Woman Physician

Physician Health Programs    

Intervention by Confrontation

Treatment   

Aftercare 

Recovery