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Rehabilitation

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Drug and Alcohol Abuse

Part of the book series: Critical Issues in Psychiatry ((CIPS))

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Abstract

There is no secret regarding the steps required to enter recovery for substance dependence.1 The process is similar to that encountered with any long-term and potentially life-threatening disorder such as diabetes or hypertension.2 The person must recognize that his or her functioning is impaired, admit that the use of substances has either caused the problems or has significantly exacerbated them, and reach a point where he or she recognizes that all possible steps must be taken to correct the situation. It is important to learn how to change the pattern of life functioning to maximize the chance that abstinence will continue and how to prevent relapses or to minimize their duration and adverse impact if they occur. Each of these steps is described for patients or clients and for their families in the companion book entitled Educating Yourself about Alcohol and Drugs.1

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References

  1. Schuckit, M. A. Educating yourself about alcohol and drugs. New York: Plenum Publishing Co., 1998.

    Google Scholar 

  2. O’Brien, C. P., & McLellan, A. T. Myths about the treatment of addiction. Lancet 347:237–240, 1996.

    PubMed  Google Scholar 

  3. Schuckit, M. A. Penny-wise, ton-foolish? The recent movement to abolish inpatient alcohol and drug treatment. Journal of Studies on Alcohol 59:5–7, 1998.

    PubMed  Google Scholar 

  4. Mueller, M. D., & Wyman, J. R. Study sheds new light on the state of drug abuse treatment nationwide. National Institute on Drug Abuse, U.S. Department of Health and Human Services, National Institutes of Health, 12:1–8, 1997.

    Google Scholar 

  5. Cox, G. B., Walker, R. D., Freng, S. A., et al. Outcome of a controlled trial of the effectiveness of intensive case management for chronic public inebriates. Journal of Studies on Alcohol 59:523–532, 1998.

    PubMed  Google Scholar 

  6. Long, C. G., Williams, M., & Hollin, C. R. Treating alcohol problems: A study of programme effectiveness and cost effectiveness according to length and delivery of treatment. Addiction 93:561–571, 1998.

    PubMed  Google Scholar 

  7. McCrady, B. S., & Langenbucher, J. W Alcohol treatment and health care system reform. Archives of General Psychiatry 53:737–746, 1996.

    PubMed  Google Scholar 

  8. Smith, T. L., Volpe, F., Hashima, J., & Schuckit, M. A. The impact of a stimulant focused program enhancement on the outcome of alcohol and/or stimulant dependent men. Alcoholism: Clinical and Experimental Rearch, in press, 2000.

    Google Scholar 

  9. Garrett, J., Landau-Stanton, J., Stanton, M. D., et al. Arise: A method for engaging reluctant alcohol-and drug-dependent individuals in treatment. Journal of Substance Abuse Treatment 14:235–248, 1997.

    PubMed  Google Scholar 

  10. Kaskutas, L. A. Pathways to self-help among women for sobriety. American Journal of Drug and Alcohol Abuse 22:259–280, 1996.

    PubMed  Google Scholar 

  11. Fleming, M. F., Lawton Barry, K., Baier Manwell, L., et al. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. Journal of the American Medical Association 277:1039–1045, 1997.

    PubMed  Google Scholar 

  12. Gordis, E. The physicians’ guide to helping patients with alcohol problems. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. NIH Publication No. 95-3769, 1995.

    Google Scholar 

  13. O’Connor, P. G., Farren, C. K., Rounsaville, B. J., & O’Malley, S. S. A preliminary investigation of the management of alcohol dependence with naltrexone by primary care providers. American Journal of Medicine 103:477–482, 1997.

    PubMed  Google Scholar 

  14. Crits-Christoph, P., & Siqueland, L. Psychosocial treatment for drug abuse. Archives of General Psychiatry 53:749–756, 1996.

    PubMed  Google Scholar 

  15. Edwards, G., & Dare, C. (Eds.). Psychotherapy, psychological treatments and the addictions. United Kingdom: Cambridge University Press, 1996.

    Google Scholar 

  16. Graham, K., Annis, H. M., Brett, P. J., & Venesoen, P. A controlled field trial of group versus individual cognitive-behavioral training for relapse prevention. Addiction 91:1127–1139, 1996.

    PubMed  Google Scholar 

  17. Trent, L. K. Evaluation of a four-versus six-week length of stay in the Navy’s alcohol treatment program. Journal of Studies on Alcohol 59:270–279, 1998.

    PubMed  Google Scholar 

  18. Stanton, M. D., & Shadish, W. R. Outcome, attrition, and family-couples treatment for drug abuse: A metaanalysis and review of the controlled, comparative studies. Psychological Bulletin 122:170–191, 1997.

    PubMed  Google Scholar 

  19. Humphreys, K., Huebsch, P. D., Finney, J. W., & Moos, R. H. A comparative evaluation of substances abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups. Alcoholism: Clinical and Experimental Research 23:558–563, 1999.

    Google Scholar 

  20. Schuckit, M. A. Recent developments in the pharmacotherapy of alcohol dependence. Journal of Consulting and Clinical Psychology 64:669–676, 1996.

    PubMed  Google Scholar 

  21. O’Brien, C. P. A range of research-based pharmacotherapies for addiction. Science 278:66–70, 1997.

    PubMed  Google Scholar 

  22. Sobell, L. C., Sobell, M. B., Toncatto, T., & Leo, G. I. What triggers the resolution of alcohol problems without treatment? Alcohol: Clinical and Experimental Research 17:217–224, 1993.

    Google Scholar 

  23. Curran, G. M., & Booth, B. M. Longitudinal changes in predictor profiles of abstinence from alcohol use among male veterans. Alcoholism: Clinical and Experimental Research 23:141–143, 1999.

    Google Scholar 

  24. Schuckit, M. A., Tipp, J. E., Smith, T. L., & Bucholz, K. K. Periods of abstinence following the onset of alcohol dependence in 1,853 men and women. Journal of Studies on Alcohol 58:581–589, 1997.

    PubMed  Google Scholar 

  25. Holder, H. D., & Blose, J. O. The reduction of health care costs associated with alcoholism treatment: A 14-year longitudinal study. Journal of Studies on Alcohol 53:293–302, 1992.

    PubMed  Google Scholar 

  26. Bunn, J. Y., Booth, B. M., Loveland Cook, C. A., et al. The relationship between mortality and intensity of inpatient alcoholism treatment. American Journal of Public Health 84:211–214, 1994.

    PubMed  Google Scholar 

  27. Schuckit, M. A., Daeppen, J.-B., Tipp, J. E., et al. The clinical course of alcohol-related problems in alcohol dependent and nonalcohol dependent drinking women and men. Journal of Studies on Alcohol 59:581–590, 1998.

    PubMed  Google Scholar 

  28. American Psychiatric Association. The diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press, 1994.

    Google Scholar 

  29. Schuckit, M. A. DSM-IV criteria for abuse and dependence: Basis for a field trial. DSM-IV Sourcebook 4:69–84, 1998.

    Google Scholar 

  30. Schuckit, M. A., Smith, R. L., & Irwin, M. Subjective predictions of outcome among alcoholics. Addiction 88:1363–1369, 1993.

    Google Scholar 

  31. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol 58:7–29, 1997.

    Google Scholar 

  32. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcoholism: Clinical and Experimental Research, 22:1300–1311, 1998.

    Google Scholar 

  33. Schuckit, M. A. It ain’t necessarily so. Journal of Studies on Alcohol 58:5–6, 1997.

    Google Scholar 

  34. Holder, H. D. Can individually directed interventions reduce population-level alcohol-involved problems? Addiction 92:5–7, 1997.

    PubMed  Google Scholar 

  35. Kenkel, D. S. Self-insurance and worksite alcohol programs: An exonometric analysis. Journal of Studies on Alcohol 58:211–219, 1997.

    PubMed  Google Scholar 

  36. Bennett, J. B., & Lehman, W. E. K. Workplace drinking climate, stress, and problem indicators: Assessing the influence of teamwork (group cohesion). Journal of Studies on Alcohol 59:608–618, 1998.

    PubMed  Google Scholar 

  37. MacDonald, S. Work-place alcohol and other drug testing: A review of the scientific evidence. Drug and Alcohol Review 16:251–259, 1997.

    PubMed  Google Scholar 

  38. Carroll, K. M. Relapse prevention as a psychosocial treatment: A review of controlled clinical trails. Experimental and Clinical Psychopharmacology 4, 1996.

    Google Scholar 

  39. Walsh, D. C., Hingson, R. W., Merrigan, D. M., et al. A randomized trial of treatment options for alcohol-abusing workers. New England Journal of Medicine 325:775–782, 1991.

    PubMed  Google Scholar 

  40. Finney, J. W., Hahn, A. C., & Moos, R. H. The effectiveness of inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects. Addiction 91:1773–1796, 1996.

    PubMed  Google Scholar 

  41. Gottheil, E., McLellan, T., & Druley, K. A. Length of stay, patient severity and treatment outcome: Sample data from the field of alcoholism. Journal of Studies on Alcohol 53:69–75, 1992.

    PubMed  Google Scholar 

  42. Allsop, S., Saunders, B., Phillips, M., & Carr, A. A trial of relapse prevention with severely dependent male problem drinkers. Addiction 92:61–74, 1997

    PubMed  Google Scholar 

  43. Daley, D. C., & Marlatt, G. A. Relapse prevention. In J. H. Lowinson, R. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 458–467.

    Google Scholar 

  44. Galanter, M. Network therapy for addiction: A model for office practice. American Journal of Psychiatry 150:28–36, 1993.

    PubMed  Google Scholar 

  45. Higgins, S. T., Budney, A. J., Bickel, W. K., & Badger, G. J. Participation of significant others in outpatient behavior treatment predicts greater cocaine abstinence. American Journal of Drug and Alcohol Abuse 20:47–56, 1994.

    PubMed  Google Scholar 

  46. McKay, J. R., McLellan, A. T., Alterman, A., I., et al. Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse. Journal of Studies on Alcohol 59:152–162, 1998.

    PubMed  Google Scholar 

  47. Thorn, B., Brown, C., Drummond, C., et al. Engaging patients with alcohol problems in treatment: The first consultation. British Journal of Addiction 87:601–611, 1992.

    Google Scholar 

  48. Volk, R. J., Steinbauer, J. R., & Cantor, S. B. Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians. Journal of Studies on Alcohol 57:203–209, 1996.

    PubMed  Google Scholar 

  49. Gordis, E., Dufour, M. C., Warren, K. R., et al. Should physicians counsel patients to drink alcohol? Journal of the American Medical Association 273:1415, 1995.

    PubMed  Google Scholar 

  50. Rosenberg, H., Devine, E. G., & Rothrock, N. Acceptance of moderate drinking by alcoholism treatment services in Canada. Journal of Studies on Alcohol 57:559–562, 1996.

    PubMed  Google Scholar 

  51. Loneck, B., Garrett, J. A., & Banks, S. M. A comparison of the Johnson Intervention with four other methods of referral to outpatient treatment. American Journal of Drug and Alcohol Abuse 22:233–246, 1996.

    PubMed  Google Scholar 

  52. Loneck, B., Garrett, J. A., & Banks, S. M. The Johnson Intervention and relapse during outpatient treatment. American Journal of Drug and Alcohol Abuse 22:363–375, 1996.

    PubMed  Google Scholar 

  53. Stimmel, B. (Ed.). Utilizing standardized patient protocols to improve clinical skills in identifying tobacco, alcohol and other drug use. New York: Josiah Macy, Jr. Foundation, 1998.

    Google Scholar 

  54. Richmond, R., Heather, N., Wodak, A., et al. Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction 90:119–132, 1995.

    PubMed  Google Scholar 

  55. Humphreys, K., Mankowski, E., Moos, R. H., & Finney, J. W. Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance use? Annals of Behavioral Medicine 21:54–60, 1999.

    PubMed  Google Scholar 

  56. Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. Network support for drinking, Alcoholics Anonymous, and long-term matching effects. Addiction 93:1313–1333. 1998.

    PubMed  Google Scholar 

  57. Watson, C. G., Hancock, M., Gearhart, L. P., et al. A comparative outcome study of frequent, moderate, occasional, and nonattenders of Alcoholics Anonymous. Journal of Clinical Psychology 53:209–214, 1997.

    PubMed  Google Scholar 

  58. Tonigan, J. S., Toscova, R., & Miller, W. R. Meta-analysis of the literature on Alcoholics Anonymous: Sample and study characteristics moderate findings. Journal of Studies on Alcohol 57:65–72, 1996.

    PubMed  Google Scholar 

  59. Florentine, R. After drug treatment: Are 12-step programs effective in maintaining abstinence? American Journal of Drug and Alcohol Abuse 25:93–116, 1999.

    Google Scholar 

  60. McCrady, B. S., Epstein, E. E., & Hirsch, L. S. Issues in the implementation of a randomized clinical trial that includes Alcoholics Anonymous: Studying AA-related behaviors during treatment. Journal of Studies on Alcohol 57:604–612, 1996.

    PubMed  Google Scholar 

  61. Ouimette, P. C., Moos, R. H., & Finney, J. W. Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcome. Journal of Studies on Alcohol 59:513–523, 1998.

    PubMed  Google Scholar 

  62. Humphreys, K., & Moos, R. H. Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services 47:709–713, 1996.

    PubMed  Google Scholar 

  63. Humphreys, K., Moos, R. H., & Finney, J. W. Life domains, Alcohol Anonymous, and role incumbency in the 3-year course of problem drinking. Journal of Nervous and Mental Disease 184:475–481, 1996.

    PubMed  Google Scholar 

  64. Connors, G. J., & Dermen, K. H. Characteristics of participants in Secular Organizations for Sobriety (SOS). American Journal of Drug and Alcohol Abuse 22:281–295, 1996.

    PubMed  Google Scholar 

  65. Litten, R. Z., Allen, J., & Fertig, J. Pharmacotherapies for alcohol problems: A review of research with for-cus on developments since 1991. Alcoholism: Clinical and Experimental Research 20:859–876, 1997.

    Google Scholar 

  66. Moncrieff, J., & Drummond, D. C. New drug treatments for alcohol problems: A critical appraisal. Addiction 92:939–947, 1997.

    PubMed  Google Scholar 

  67. American Psychiatric Association, Work Group on Substance Use Disorders. Practice guideline for the treatment of patients with substance use disorders: Alcohol, cocaine, opioids. American Journal of Psychiatry 153 (suppl.):1–59, 1995.

    Google Scholar 

  68. Besson, J., Aeby, F., Kasas, A., et al. Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: A controlled study. Alcoholism: Clinical and Experimental Research 22:573–579, 1998.

    Google Scholar 

  69. Sass, H., Soyka, M., Mann, K., & Zieglgänsberger, W. Relapse prevention by acamprosate: Results from a placebo-controlled study on alcohol dependence. Archives of General Psychiatry 53:673–680, 1996.

    PubMed  Google Scholar 

  70. Schneider, U., Wohlfarth, K., Schulze-Bonhage, A., et al. Effects of acamprosate on memory in healthy young subjects. Journal of Studies on Alcohol 60:172–175, 1999.

    PubMed  Google Scholar 

  71. Whitworth, A. D., Fischer, F., Lesen, O. M., et al. Camparison of acamprosate and placebo in long-term treatment of alcohol dependence. Lancet 347:1438–1442, 1996.

    PubMed  Google Scholar 

  72. Poldrugo, F. Acamprosate treatment in a long-term community-based alcohol rehabilitation programme. Addiction 92:1537–1546, 1997.

    PubMed  Google Scholar 

  73. Davidson, D., & Amit, Z. Naltrexone blocks acquisition of voluntary ethanol intake in rats. Alcoholism: Clinical and Experimental Research 21:677–683, 1997.

    Google Scholar 

  74. Mason, B. J., Salvato, F. R., Williams, L. D., et al. A double-blind, placebo-controlled study of oral nalme-fene for alcohol dependence. Archives of General Psychiatry 56:719–724, 1999.

    PubMed  Google Scholar 

  75. Cowen, M. S., Rezvani, A. H., Jarrott, B., & Lawrence, A. J. Ethanol consumption by fawn-hooded rats following abstinence: Effect of naltrexone and changes in μ-opioid receptor density. Alcoholism: Clinical and Experimental Research 23:1008–1014, 1999.

    Google Scholar 

  76. Boyle, A. E. L., Stewart, R. B., Macenski, M. J., et al. Effects of acute and chronic doses of naltrexone on ethanol self-administration in Rhesus monkeys. Alcoholism: Clinical and Experimental Research 22:359–366, 1998.

    Google Scholar 

  77. Volpicelli, J. R., Alterman, A. I., Hayashida, M., & O’Brien, C. P. Naltrexone in the treatment of alcohol dependence. Archives of General Psychiatry 49:876–880, 1992.

    PubMed  Google Scholar 

  78. O’Malley, S. S., Jaffe, A. J., Chang, G., et al. Naltrexone and coping skills therapy for alcohol dependence. Archives of General Psychiatry 49:881–887, 1992.

    PubMed  Google Scholar 

  79. De Wit, H., & Svenson, J. Effects of naltrexone on ethanol consumption in social drinkers. Paper presented at the RSA Annual Meeting, June, 1997.

    Google Scholar 

  80. Volpicelli, J. R., Rhines, K. C., Rhines, J. S., et al. Naltrexone and alcohol dependence: Role of subject compliance. Archives of General Psychiatry 54:737–742, 1997.

    PubMed  Google Scholar 

  81. Davidson, D., Palfai, T., Bird, C., & Swift, R. Effects of naltrexone on alcohol self-administration in heavy drinkers. Alcoholism: Clinical and Experimental Research 23:195–203, 1999.

    Google Scholar 

  82. Croop, R. S., Faulkner, E. G., & Labriola, D. F The safety profile of naltrexone in the treatment of alcoholism. Archives of General Psychiatry 54:1130–1135, 1997.

    PubMed  Google Scholar 

  83. Wright, C., Moore, R. D., Grodin, D. M., et al. Screening for disulfiram-induced liver test dysfunction in an inpatient alcoholism program. Alcoholism: Clinical and Experimental Research 17:184–186, 1993.

    Google Scholar 

  84. Kristenson, H. How to get the best out of antabuse. Alcohol & Alcoholism 30:775–783, 1995.

    Google Scholar 

  85. Jacobsen, D., Sebastina, S., Blomstrand, R., & McMartin, K. E. 4-Methylpyrazole: A controlled study of safety in healthy human subjects after single, ascending doses. Alcoholism: Clinical and Experimental Research 12:516–522, 1988.

    Google Scholar 

  86. Zorzon, M., Mase’ G., Biasutti, E., et al. Acute encephalopathy and polyneuropathy after disulfiram intoxication. Alcohol & Alcoholism 30:629–631, 1995.

    Google Scholar 

  87. Hughes, J. C., & Cook, C. C. H. The efficacy of disulfiram: A review of outcome studies. Addiction 92:381–395, 1997.

    PubMed  Google Scholar 

  88. Fuller, R. K., Branchey, L., Brightwell, D. R., et al. Disulfiram treatment of alcoholism: A Veterans Administration cooperative study. Journal of the American Medical Association 256:1449–1455, 1986.

    PubMed  Google Scholar 

  89. Allen, J. P., & Litten, R. Z. Techniques to enhance compliance with disulfiram. Alcoholism: Clinical and Experimental Research 16:1035–1041, 1992.

    Google Scholar 

  90. Johnsen, J., & Morland, J. Disulfiram implant: A double-blind placebo controlled follow-up on treatment outcome. Alcoholism: Clinical and Experimental Research 15:532–536, 1991.

    Google Scholar 

  91. Carroll, K. M., Nich, C., Ball, S. A., et al. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction 93:713–728, 1998.

    PubMed  Google Scholar 

  92. Peachey, J. E., Annis, H. M., Bornstein, E. R., et al. Calcium carbamide in alcoholism treatment. Part 1: A placebo-controlled, double-blind clinical trial of short-term efficacy. British Journal of Addiction 84:877–887, 1989.

    PubMed  Google Scholar 

  93. Schuckit, M. A., Mazzanti, C., Smith, T. L., et al. Selective genotyping for the role of 5-HT2A, 5-HT2C, and GABAα6 receptors and the serotonin transporter in the level of response to alcohol: A pilot study. Biological Psychiatry 45:647–651, 1999.

    PubMed  Google Scholar 

  94. Higley, J., Hasert, M., Suomi, S., & Linnoila, M. The serotonin reuptake inhibitor sertraline reduces excessive alcohol consumption on nonhuman primates: Effect of stress. Neuropsychopharmacology 18:431–443, 1998.

    PubMed  Google Scholar 

  95. George, D. T., Benkelfat, C., Rawlings, R. R., et al. Behavioral and neuroendocrine responses to m-chlorophenylpiperazine in subtypes of alcoholics and in healthy comparison subjects. American Journal of Psychiatry 154:81–87, 1997.

    PubMed  Google Scholar 

  96. Angelone, S. M., Bellini, L., De Bella, D., & Catalano, M. Effects of fluvoxamine and Citalopram in maintaining abstinence in a sample of Italian detoxified alcoholics. Alcohol & Alcoholism 33:151–156, 1998.

    Google Scholar 

  97. Pettinati, H. M., Volpicelli, J. R., Rukstalis, M., et al. Placebo controlled trial of sertraline (Zoloft) for primary alcoholism. Symposium presented at the 1998 Research Society of Alcoholism, Hilton Head, South Carolina, June, 1998.

    Google Scholar 

  98. Kabel, D. I., & Petty, F. A placebo-controlled, double-blind study of fluoxetine in severe alcohol dependence: Adjunctive pharmacotherapy during and after inpatient treatment. Alcoholism: Clinical and Experimental Research 20:780–784, 1996.

    Google Scholar 

  99. Kranzler, H. R., Burleson, J. A., Korner, P., et al. Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. American Journal of Psychiatry 152:391–397, 1995.

    PubMed  Google Scholar 

  100. Kranzler, H. R., Burleson, J. A., Brown, J., & Babor, T. R. Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in Type B alcoholics. Alcoholism: Clinical and Experimental Research 20:1534–1541, 1996.

    Google Scholar 

  101. Cornelius, J. R., Salloum, I. M., Ehler, J. G., et al. Fluoxetine in depressed alcoholics. Archives of General Psychiatry 54:700–705, 1997.

    PubMed  Google Scholar 

  102. Schuckit, M. A. Clinical aspects of the use of antidepressant medications in persons with developmental disabilities. Developmental Disabilities: Clinical Insights 4, San Diego Regional Center for the Developmentally Disabled, 1998.

    Google Scholar 

  103. Kranzler, H. R., Burleson, J. A., Del Boca, R. K., et al. Buspirone treatment of anxious alcoholics: A placebo-controlled trial. Archives of General Psychiatry 51:720–731, 1994.

    PubMed  Google Scholar 

  104. Mason, B. J., Kocsis, J. H., Ritvo, E. C., & Cutler, R. B. A double-blind placebo-controlled trial of desipramine in primary alcoholics stratified on the presence or absence of major depression. Journal of the American Medical Association 275:1–7, 1996.

    Google Scholar 

  105. Nunes, E. V., McGrath, P. J., Quitkin, F. M., et al. Predictors of antidepressant response in depressed alcoholic patients. American Journal on Addictions 5:308–312, 1996.

    Google Scholar 

  106. Mueller, T. I., Stout, R. L., Rudden, S., et al. A double-blind, placebo-controlled pilot study of carbamazepine for the treatment of alcohol dependence. Alcoholism: Clinical and Experimental Research 21:86–92, 1997.

    Google Scholar 

  107. Schuckit, M. A. A clinical review of the use of anticonvulsive medications in persons with developmental disabilities. Developmental Disabilities: Clinical Insights 2, San Diego Regional Center for the Develop-mentally Disabled, 1998.

    Google Scholar 

  108. Naranjo, C. A., Dongier, M., & Bremner, K. E. Long-acting injectable bromocriptine does not reduce relapse in alcoholics. Addiction 92:969–978, 1997.

    PubMed  Google Scholar 

  109. Wiesbeck, G. A. Weijers, H.-G., Chick, J., et al. Ritanserin in relapse prevention in abstinent alcoholics: Results from a placebo-controlled double-blind international multicenter trial. Alcoholism: Clinical and Experimental Research 23:230–235, 1999.

    Google Scholar 

  110. Ancoli-Israel, S. All I want is a good night’s sleep. St. Louis: Mosby, 1996.

    Google Scholar 

  111. Storti, S. A. Alcohol disabilities and rehabilitation. San Diego, CA: Singular Publishing Group, 1997.

    Google Scholar 

  112. Goodwin, D. W., & Guze, S. B. Psychiatric diagnosis (5th ed.). New York: Oxford University Press, 1996.

    Google Scholar 

  113. Dorus, W., Ostrow, D. G., Anton, R., et al. Lithium treatment of depressed and nondepressed alcoholics. Journal of the American Medical Association 262:1646–1652, 1989.

    PubMed  Google Scholar 

  114. Raimo, E. B., & Schuckit, M. A. Alcohol dependence and mood disorders. Addictive Behaviors 23:933–946, 1998.

    PubMed  Google Scholar 

  115. Rounsaville, B. J., & Carroll, K. M. Individual psychotherapy. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 430–440.

    Google Scholar 

  116. Washton, A. M. Structured outpatient group therapy with alcohol and substance abusers. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 440–448.

    Google Scholar 

  117. Howard, M. O., Ellsins, R. L., Rimmele, C., & Smith, J. W Chemical aversion treatment of alcohol dependence. Drug and Alcohol Dependence 29:107–143, 1991.

    PubMed  Google Scholar 

  118. Daeppen, J.-B., Smith, T. L., Danko, G. P., et al. Clinical correlates of cigarette smoking and nicotine dependence in alcohol dependent men and women. Submitted to Alcohol and Alcoholism.

    Google Scholar 

  119. Patten, C. A., Martin, J. E., Myers, M. G., et al. Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression. Journal of Studies on Alcohol 59:327–335, 1998.

    PubMed  Google Scholar 

  120. Bobo, J. K., McIlvain, H. E., Lando, R., Walker, D., & Leed-Kelly, A. Effect of smoking cessation counseling on recovery from alcoholism: Findings from a randomized community intervention trial. Addiction 93:877–887, 1998.

    PubMed  Google Scholar 

  121. McKay, J. R., Alterman, A. I., McLellan, A. T., & Snider, E. C. Treatment goals, continuity of care, and outcome in a day hospital substance abuse rehabilitation program. American Journal of Psychiatry 151:254–259, 1994.

    PubMed  Google Scholar 

  122. Beattie, M. C., Longabaugh, R., & Fava, J. Assessment of alcohol-related workplace activities: Development and testing of “your workplace.” Journal of Studies on Alcohol 53:469–475, 1992.

    PubMed  Google Scholar 

  123. Holdcraft, L. C., Iacono, W. G., & McGue, M. K. Antisocial personality disorder and depression in relation to alcoholism: A community-based sample. Journal of Studies on Alcohol 59:222–226, 1998.

    PubMed  Google Scholar 

  124. Del Rio, M., Mino, A., & Perneger, T. V. Predictors of patient retention in a newly established methadone maintenance treatment programme. Addiction 92:1353–1360, 1997.

    PubMed  Google Scholar 

  125. Saxon, A. J., Wells, E. Z., Fleming, C., et al. Pre-treatment characteristics, program philosophy, and level of ancillary services as predictors of methadone maintenance treatment outcome. Addiction 91:1197–1209, 1996.

    PubMed  Google Scholar 

  126. Lowinson, J. H., Payte, J. T., Joseph, H., et al. Methadone maintenance. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 405–415.

    Google Scholar 

  127. Maddux, J. G., & Desmond, D. P. Ten-year follow-up after admission to methadone maintenance. American Journal of Drug and Alcohol Abuse 18:289–303, 1992.

    PubMed  Google Scholar 

  128. Barnett, P. G. The cost-effectiveness of methadone maintenance as a health care intervention. Addiction 94:479–488, 1999.

    PubMed  Google Scholar 

  129. Ball, J., & Ross, A. The effectiveness of methadone maintenance treatment. New York: Springer-Verlag, 1991.

    Google Scholar 

  130. Kraft, M. K., Rothbard, A. B., Hadley, T. R., et al. Are supplementary services provided during methadone maintenance really cost-effective? American Journal of Psychiatry 154:1214–1219, 1997.

    PubMed  Google Scholar 

  131. Jaffe, J. H. Opioid-related disorders. In H. I. Kaplan & B. J. Sadock, Comprehensive textbook of psychiatry (6th ed.), Baltimore, MD: Williams & Wilkins, 1995, 842–864.

    Google Scholar 

  132. Magura, S., Nwakeze, P. C., & Demsky, S. Pre-and in-treatment predictors of retention in methadone treatment using survival analysis. Addiction 93:51–60, 1998.

    PubMed  Google Scholar 

  133. Kosten, T. R. A 2.5 year follow-up of cocaine use among treated opiate addicts (the relationship with depression). Archives of General Psychiatry 44:281–284, 1987.

    PubMed  Google Scholar 

  134. Dolan, K. A., Wodak, A. D., & Hall, W. D. Methadone maintenance treatment reduces heroin injection in New South Wales prisons. Drug and Alcohol Review 17:153–158, 1998.

    PubMed  Google Scholar 

  135. Maddux, J. F., Prihoda, T. J., & Vogtsberger, K. N. The relationship of methadone dose and other variables to outcomes of methadone maintenance. American Journal on Addictions 6:246–255, 1997.

    PubMed  Google Scholar 

  136. Schottenfeld, R. S., Pakes, J. R., Oliveto, A., et al. Buprenorphine vs. methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Archives of General Psychiatry 54:713–720, 1997.

    PubMed  Google Scholar 

  137. Maddux, J. F., Desmond, D. P., & Esquivel, M. Rapid admission and retention on methadone. American Journal of Drug and Alcohol Abuse 21:533–547, 1995.

    PubMed  Google Scholar 

  138. Caplehorn, J. R. M. Deaths in the first two weeks of maintenance treatment in NSW in 1994: Identifying cases of iatrogenic methadone toxicity. Drug and Alcohol Review 17:9–17, 1998.

    PubMed  Google Scholar 

  139. Hulse, G. K., Milne, E., English, D. R., & Holman, C. D. J. Assessing the relationship between maternal opiate use and neonatal mortality. Addiction 93:1033–1042, 1998.

    PubMed  Google Scholar 

  140. Kanof, P. D., Aronson, M. J., & Ness, R. Organic mood syndrome associated with detoxification from methadone maintenance. American Journal of Psychiatry 150:423–428, 1993.

    PubMed  Google Scholar 

  141. Jones, J. E., Strain, E. C., Bigelow, D. E., Walsh, S. L., et al. Induction with levomethadyl acetate. Archives of General Psychiatry 55:729–736, 1998.

    PubMed  Google Scholar 

  142. Glanz, M., Klawansky, S., McAullife, W., & Chalmers, T. Methadone vs. L-alpha-acetylmethadol (LAAM) in the treatment of opiate addiction: A meta-analysis of the randomized, controlled trials. The American Journal on Addictions 6:339–349, 1997.

    PubMed  Google Scholar 

  143. Kuhlman, J. J., Jr., Levine, B., Johnson, R. E., et al. Relationship of plasma buprenorphine and nor-buprenorphine to withdrawal symptoms during dose induction, maintenance, and withdrawal from sublingual buprenorphine. Addiction 93:549–559, 1998.

    PubMed  Google Scholar 

  144. O’Connor, P. G., Oliveto, A. H., Shi, J. M., et al. A pilot study of primary-care-based buprenorphine maintenance for heroin dependence. American Journal of Drug and Alcohol Abuse 22:523–531, 1996.

    PubMed  Google Scholar 

  145. Ling, W., Charuvastra, C., Collins, J. F., et al. Buprenorphine maintenance treatment of opiate dependence: A multicenter, randomized clinical trial. Addiction 93:475–486, 1998.

    PubMed  Google Scholar 

  146. Strang, J., & Sheridan, J. Heroin prescribing in the British system in the mid-1990s. Drug and Alcohol Review 16:7–16, 1997.

    PubMed  Google Scholar 

  147. Moldovanyi, A., Ladewig, D., Affentranger, P., et al. Morphine maintenance treatment of opioid-dependent out-patients. European Addiction Research 2:208–212, 1996.

    Google Scholar 

  148. Shufman, E. N., Porat, S., Witztum, E., et al. The efficacy of naltrexone in preventing reabuse of heroin after detoxification. Biological Psychiatry 35:935–945, 1994.

    PubMed  Google Scholar 

  149. San, L., Pomarol, G., Peri, J. M., et al. Follow-up after a six-month maintenance period on naltrexone versus placebo in heroin addicts. British Journal of Addiction 86:983–990, 1991.

    PubMed  Google Scholar 

  150. Foy, A., Sadler, C., & Taylor, A. An open trial of naltrexone for opiate dependence. Drug and Alcohol Review 17:167–174, 1998.

    PubMed  Google Scholar 

  151. Farren, C. K. The use of naltrexone, an opiate antagonist, in the treatment of opiate addiction. Irish Journal of Psychological Medicine 14:26–31, 1997.

    Google Scholar 

  152. Greenstein, R. A., O’Brien, C. P., McLellan, A. T., et al. Naltrexone: A short-term treatment of opiate dependence. American Journal of Drug and Alcohol Abuse 8:291–300, 1981.

    PubMed  Google Scholar 

  153. Cornish, J. W., Metzger, D., Woody, G. E., et al. Naltrexone pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment 14:529–534, 1997.

    PubMed  Google Scholar 

  154. Moreno, R. M., & Rosado, T. D. Follow-up of a 12-month naltrexone maintenance programme. Adicciones 8:5–18, 1996.

    Google Scholar 

  155. Smith, M. O., Brėwington, V., Cuillen, P., et al. Acupuncture and transcutaneous electrical nerve stimulation: Afferent nerve stimulation (ANS) in the treatment of addiction. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 484–492.

    Google Scholar 

  156. Riet, G. T., Kleijnen, J., & Knipschild, P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379–382, 1990.

    PubMed  Google Scholar 

  157. Gariti, P., Auriacombe, M., Incmikoski, R., et al. A randomized double-blind study of neuroelectric therapy in opiate and cocaine detoxification. Journal of Substance Abuse 4:299–308, 1992.

    PubMed  Google Scholar 

  158. Stier, K. Nature’s easier way down? Asiaweek, September 26, 1997.

    Google Scholar 

  159. O’Brien, C. P., Hardman, J. D., Leinbird, L. E., et al. Drug addiction and drug abuse. In J. G. Harman., L. E. Limbird, P. B. Molinoff, et al. (Eds.), The pharmacological basis of therapeutics (9th ed.). New York: McGraw-Hill, 1995, pp. 557–577.

    Google Scholar 

  160. O’Brien, M. W., & Devlin, C. J. The therapeutic community. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 400–405.

    Google Scholar 

  161. De Leon, G. Therapeutic communities. In P. J. Ott, R. E. Tarter, & R. T. Ammerman (Eds.), Sourcebook on substance abuse: Etiology, epidemiology, assesssment, and treatment. Needham Heights, MA: Allyn & Bacon, 1999, pp. 121–136.

    Google Scholar 

  162. Atkinson, J. H., Slater, M. A., Patterson, T. L., et al. Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: A controlled study. Pain 45:111–121, 1991.

    PubMed  Google Scholar 

  163. Portenoy, R. K., & Payne, R. Acute and chronic pain. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 563–591.

    Google Scholar 

  164. Simpson, D. D., Joe, G. W., Fletcher, B. W., et al. A national evaluation of treatment outcomes for cocain dependence. Archives of General Psychiatry 56:507–514, 1999.

    PubMed  Google Scholar 

  165. Gottheil, E., Weinstein, S. P., Sterling, R. D., Lundy, A., & Serota, R. D. A randomized controlled study of the effectiveness of intensive outpatient treatment for cocaine dependence. Psychiatric Services 49:782–787, 1998.

    PubMed  Google Scholar 

  166. Mendelson, J. H., & Mello, N. K. Management of cocaine abuse and dependence. New England Journal of Medicine 334:965–972, 1996.

    PubMed  Google Scholar 

  167. Crits-Christoph, P., Siqueland, L., Blaine, J., et al. Psychosocial treatments for cocaine dependence. National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archives of General Psychiatry 56:493–502, 1999.

    PubMed  Google Scholar 

  168. Hoffman, J. A., Caudill, B. D., Koman, J. J., III., et al. Psychosocial treatments for cocaine abuse: 12-month treatment outcomes. Journal of Substance Abuse Treatment 13:3–11, 1996.

    PubMed  Google Scholar 

  169. McKay, J. R., Alterman, A. I., Cacciola, J. S., et al. Continuing care for cocaine dependence: Comprehensive two-year outcomes. Journal of Consulting and Clinical Psychology 67:420–427, 1999.

    PubMed  Google Scholar 

  170. Monti, P. M., Rohsenow, D. J., Michalec, E., et al. Brief coping skills treatment for cocaine abuse: Substance use outcomes at three months. Addiction 92:1717–1728, 1997.

    PubMed  Google Scholar 

  171. King, G. R., & Ellinwood, E. H. Amphetamines and other stimulants. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 207–223.

    Google Scholar 

  172. Silverman, K., Higgins, S. T., Brooner, R. K., et al. Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry 53:409–415, 1996.

    PubMed  Google Scholar 

  173. Kosten, T. R., Morgan, C. M., Falcione, J., & Schottenfeld, R. S. Pharmacotherapy for cocaine-abusing methadone-maintained patients using amantadine or desipramine. Archives of General Psychiatry 49:894–898, 1992.

    PubMed  Google Scholar 

  174. Gold, M. S., & Miller, N. S. Cocaine (and crack) neurobiology. In J. H. Lowinson, P. Ruiz, R. B. Millman, & J. G. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed.). Baltimore, MD: Williams & Wilkins, 1996, pp. 166–181.

    Google Scholar 

  175. Oliveto, A., Kosten, T. R., Schottenfeld, R., et al. Desipramine, amantadine, or fluoxetine in buprenorphine-maintained cocaine users. Journal of Substance Abuse Treatment 12:423–428, 1995.

    PubMed  Google Scholar 

  176. Gorelick, D. A. Pharmacologic therapies for cocaine and other stimulant addiction. In A. W. Graham, T. K. Schultz, & B. B. Wilford (Eds.), Principles of addiction medicine (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine, 1998, pp. 531–544.

    Google Scholar 

  177. Hameedi, F. A., Rosen, M. I., McCance-Katz, E. F., et al. Behavioral, physiological, and pharmacological interaction of cocaine and disulfiram in humans. Biological Psychiatry 37:560–563, 1995.

    PubMed  Google Scholar 

  178. Halikas, J. A., Crosby, R. D., Pearson, V. L., & Graves, N. M. A randomized double-blind study of carba-mazepine in the treatment of cocaine abuse. Clinical Pharmacology & Therapeutics 62:89–105, 1997.

    Google Scholar 

  179. Kosten, T. R. The pharmacotherapy elapse prevention using anticonvulsants. American Journal on Addictions 7:205–209, 1998.

    PubMed  Google Scholar 

  180. Kranzler, H. R., Bauer, L. O., Hersh, D., & Klinghoffer, V. Carbamazepine treatment of cocaine dependence: A placebo-controlled trial. Drug and Alcohol Dependence 38:203–211, 1995.

    PubMed  Google Scholar 

  181. Levin, F. R., McDowell, D., Evans, S. M., et al. Pergolide mesylate for cocaine abuse: A controlled preliminary trial. American Journal on Addictions 8:120–127, 1999

    PubMed  Google Scholar 

  182. Luciano, D. Observations on treatment with ibogaine. American Journal on Addictions 7:89–90, 1998.

    PubMed  Google Scholar 

  183. Schuckit, M. A. Substance use disorders. British Medical Journal 314:1605–1608, 1997.

    PubMed  Google Scholar 

  184. Giros, B., Jaber, J., Jones, S. R., Wightman, R. D., & Caron, M. D. Hyperlocomotion and indifference to cocaine and amphetamine in the mice lacking the dopamine transporter. Nature 379:606–612, 1996.

    PubMed  Google Scholar 

  185. Venance, L., Piomelli, D., Clowinski, J., & Glaume, C. Inhibition by anadamide of gap junctions and intercellular calcium signalling in striatal astrocytes. Nature 378:727–730, 1995.

    Google Scholar 

  186. Carrera, M. R. A., Ashley, J. A., Parsons, L. D., et al. Suppression of psychoactive effects of cocaine by active immunization. Nature 378:727–730, 1995.

    PubMed  Google Scholar 

  187. Hughes, J. R., Fiester, S., Goldstein, M., et al. Practice guideline for the treatment of patients with nicotine dependence. American Journal of Psychiatry 153:1–31, 1996.

    Google Scholar 

  188. Hajek, P., & West, R. Treating nicotine dependence: The case for specialist smokers’ clinics. Addiction 93:637–640, 1998.

    PubMed  Google Scholar 

  189. Niaura, R., Abrams, D. B., Shadel, W. G., et al. Cue exposure treatment for smoking relapse prevention: a controlled clinical trial. Addiction 94:685–695, 1999.

    PubMed  Google Scholar 

  190. Glover, E. D., Sachs, D. P. L., Stitzer, M. L., et al. Smoking cessation in highly dependent smokers with 4 mg nicotine polacrilex. American Journal of Health behavior 20:319–332, 1996.

    Google Scholar 

  191. Swan, G. E., Jack, L. M., & Ward, M. M. Subgroups of smokers with different success rates after use of transdermal nicotine. Addiction 92:207–218, 1997.

    PubMed  Google Scholar 

  192. Richmond, R. L., Kehoe, L., & de Almeida Neto, A. C. Effectiveness of a 24-hour transdermal nicotine patch in conjunction with a cognitive-behavioural programme: One year outcome. Addiction 92:27–31, 1997.

    PubMed  Google Scholar 

  193. Hughes, J. R., & Liguori, A. Bibliographical analysis of research on smoking cessation therapy. Tobacco Control 5:111–114, 1997.

    Google Scholar 

  194. Schneider, N. G., Olmstead, R., Vaghaiwalla Mody, F., et al. Efficacy of nicotine nasal spray in smoking cessation. Addiction 90:1671–1682, 1995.

    PubMed  Google Scholar 

  195. Franks, P., Harp, J., & Bell, B. Randomized, controlled trial of Clonidine for smoking cessation in a primary care setting. Journal of the American Medical Association 262:3011–3013, 1989.

    PubMed  Google Scholar 

  196. Blondal, T., Gudmundsson, L. J., Tomasson, K., et al. The effects of fluoxetine combined with nicotine inhalers in smoking cessation—a randomized trial. Addiction 94:1007–1015, 1999.

    PubMed  Google Scholar 

  197. Hughes, J. R., Stead, L. F., & Lancaster, T. R. Anxiolytics and antidepressants in smoking cessation. In T. Lancaster, C. Silagy, & D. Fullerton (Eds.), Tobacco addiction module of the Cochrane database of systematic reviews. Oxford: The Cochrane Collaboration, 1997.

    Google Scholar 

  198. Hall, S. M., Reus, B. I., Munoz, R. F., Sees, K. L., Humfleet, G., Hartz, D. T., Frederick, D., & Triffleman, E. Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Archives of General Psychiatry 55:683–690, 1998.

    PubMed  Google Scholar 

  199. Hayford, K. E., Patten, C. A., Rummans, T. A., et al. Efficacy of bupropion for smoking cessation in smokers with a former history of major depression of alcoholism. British Journal of Psychiatry 174:173–178, 1999.

    PubMed  Google Scholar 

  200. Goldstein, M. G. Bupropion sustained release and smoking cessation. Journal of Clinical Psychiatry 4:66–72, 1998.

    Google Scholar 

  201. Hurt, R. D., Sachs, D. P., Glover, E. D., et al. A comparison of sustained-release bupropion and placebo for smoking cessation. New England Journal of Medicine 337:1195–1202, 1997.

    PubMed  Google Scholar 

  202. Ashenden, R., Silagy, C. A., Lodge, M., & Fowler, G. A meta-analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review 16:33–40, 1997.

    PubMed  Google Scholar 

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Schuckit, M.A. (2000). Rehabilitation. In: Drug and Alcohol Abuse. Critical Issues in Psychiatry. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-3232-0_15

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