Page numbers refer to the print edition but are hyperlinked to the appropriate location in the e-book.
abstinence,
23–25,
37,
40,
110,
197–99,
203,
224,
225,
227,
233,
238,
239acute withdrawal,
80,
170addiction: definition,
8; as brain disease,
48; as chronic, relapsing disease,
8,
36–37,
40,
107,
195,
197,
203,
254,
257,
260; dark side of,
88,
154,
164,
170,
178,
184,
258; molecular switches into,
258; as associated with growing up/living in poverty, being exposed to violence, having low education level,
140; psychomotor stimulant theory of,
63; relation of impulsivity to,
98–103; science of,
7,
8,
247,
259,
260; self-medication view of,
77addiction counseling,
190addiction medicine: fundamental tenet of (
see addiction: as chronic, relapsing disease); as having difficulties recruiting practitioners,
260; need for change in practice of,
189–90; opportunities in,
7; science and humanism as inseparable in,
192–93addiction risk: contribution to from genes and environmental factors,
141,
145,
147,
155,
159,
160,
161; identification of specific traits/genes that carry,
150;impulsivity as associated with,
98;making it feel real to people,
149Addiction Severity Index (ASI),
191addiction transmitter,
189addictive behavior: need for scientific understanding of,
7; neurobiology of,
5–6addictive disorders: argument against habit formation as major mechanism behind,
71; dopamine receptors and,
73; emotional toll of,
5; gene variants that are important for,
162; impulsivity and,
99; lack of compassion for people suffering from,
5 (
see also alcoholism: viewed as moral failing); many pathways to getting diagnosis of,
150;as moderately to highly heritable,
142;viewed as moral defects,
256admission: history taken at,
104–5; involuntary,
13,
14; policies,
3–4adrenocorticotropic hormone (ACTH),
128affective homeostasis,
82after-the-fact analysis,
221,
225alcohol: actions of as more complex and varied than those of other addictive drugs,
181; as activating nucleus accumbens,
66; addictive properties of as influenced by characteristics of user,
164; as cause of death,
9; cost of damage inflicted by,
5; deaths each year from,
4; early use of,
180; effect of on lifespan,
4–5; effect of on mesolimbic dopamine transmission,
65; more people as having problems with as compared to illicit drugs,
28; as the most damaging drug,
16; multifaceted effects of,
183; as not directly interacting with any specific brain receptor,
217; percent of people addicted to as only minority of people who consume,
16; percent of population consuming,
16; physical withdrawal from,
83; as producing anxiety and low mood,
80;rate of consumption of,
19; self-administration of in animals,
85; self-medication theory and,
78; as substance category of its own,
164; as third most common preventable cause of death(U.S.),
4; total disability-adjusted life years as result of,
16; use of as escalating over time,
25; use of term,
179alcohol addiction: equated with alcoholism,
16; rate of,
16alcohol dependence: percent of Americans qualifying for ever having diagnosis of,
28; trajectories to diagnosis of,
29“Alcohol Dependence” (Edwards and Gross),
18alcoholism: clinical alcoholism,
29; as running in families,
139; viewed as moral failing,
8,
103,
233,
243The Alcoholism and Addiction Cure (C. Prantiss),
185
alcohol-related disability,
16Alcohol Use Disorder Identification Test (AUDIT),
196American Psychiatric Association,
26,
27,
31ammonium bicarbonate,
175amphetamine-like drugs,
164analysis: after-the-fact analysis,
221,
225;completer analysis,
236–37; intent-to-treat analysis,
237; linkage analysis,
159; meta-analysis,
186,
204,
209,
216,
219,
223,
224,
237ancient Greeks: alcohol use,
180; on genetics in alcoholism risk,
139; wine and,
18animals, experiments on,
100,
102,
108,
109,
115–16,
119,
127.
See also mice, experiments on;
monkeys, experiments on;
rats, experiments onanticraving medications,
8,
193,
252antihypertensive treatment,
27,
30antipsychotic medications,
62antisocial personality: disorder,
152; and risk of addiction,
79approaches: long-term disease management approach,
198; multiphasic approach (to treatment),
244; three-sphere approach, to brain circuits, behavior, and addiction,
56; whole-genome association approach,
161Asian flush syndrome,
159,
218An Astonishing Hypothesis (Crick),
44
attention deficit hyperactivity disorder (ADHD),
96,
99,
258awards/prizes: Anderson Award,
245,
247; Jacob P. Waletzky Memorial Award,
109; Jellinek Memorial Award,
109; Lasker Medical Research Award,
69,
206; Mark Keller Award,
147; Marlatt Mentorship Award,
81; Nobel Prize,
69,
127,
128,
156
Babylonia, distilled spirits in,
180basal ganglia system,
62,
70behavioral choices, role of,
37behavioral relapse prevention treatments,
199between-systems adaptations,
82bipolar disorder, and risk of addiction,
79,
80brain: changes in as triggered by addiction,
257–58; chemical anatomy of,
61–62; healthy one as compared to addicted one,
83; as master gland,
128; plasticity of,
258.
See also specific components of the brainbrain mechanisms (of addiction),
51British, and opium trade,
166built-in brake (on alcohol intake),
153Butler Center for Research,
245
Campral (acamprosate),
224Centers for Disease Control and Prevention (CDC),
4,
5Champix (varenicline),
216change, readiness for,
192Chantix (varenicline),
216charlatans (in treatment field),
262–63choices: addicts as often making bad ones,
92–93; facing investigators studying new alcoholism treatment,
110Christianity, on happiness,
58clinical diagnostic criteria,
20,
22–23cocaine: alcohol as greater cause of death/disability,
9; barriers to obtaining/using as higher than for nicotine,
20; as binding to more than one place in the brain,
176; in Coca-Cola,
174; deaths from as compared to deaths from prescription opioid analgesics,
214; different methods of using,
175;effect of on mesolimbic dopamine transmission,
65; euphoria experience from,
20; experiments on monkeys with,
73; extraction of,
174; harm to self and others inflicted by as less than that of alcohol,
16; as having unusual chemistry,
175; high produced as more uniform than that from heroin or morphine,
177; medications for addiction to,
229; minority of users as developing particularly destructive relationship with,
20; naming of,
174;number of users of,
178; as outlawed most places outside of South America,
174; in Pemberton’s French Wine Coca,
174; as producing anxiety and low mood,
80; as the prototypical psychostimulant,
179; as psychostimulant,
164; as reliably producing a high,
67; self-administration of in animals,
85; self-medication theory and,
78; as stimulating movement in general,
63; user study,
117; Volkow on use of,
64cognitive neuroscience,
59Collaborative on the Genetics of Alcoholism (COGA),
159,
160common language, need for,
22community-based mental health,
243Compendium der Psychiatrie (Kraepelin),
243
compulsive drug use,
24,
25,
27concordance (in twin pairs),
146conditioned drug cues,
115conditioned place preference (CPP),
63context-induced relapse,
121contingency management,
204crashes (after binges),
178craving,
21,
25,
51,
88,
115–20,
125,
126,
133–34,
170,
200,
207,
213,
216cue exposure therapy (CET),
120,
202
dark matter of the genome,
160deconstructing addiction,
154deep brain stimulation (DBS),
119delayed gratification,
98delta-opioid receptor,
69,
70denial, limitlessness of,
15dependence: alcohol dependence, percent of Americans qualifying for ever having diagnosis of,
28; alcohol dependence, trajectories to diagnosis of,
29; diagnosis of,
20; physical dependence,
21,
30,
78,
86,
87; physiological dependence,
21; psychological dependence,
21detoxification,
14,
34,
37,
39,
63,
171,
197,
198,
199,
209,
253diacetyl-morphine (Heroin),
167Diagnostic and Statistical Manual of Mental Disorders (DSM),
266n6
discontinuation syndrome,
30discounting (value of future outcome),
92,
97,
98discrepancy, importance of provider’s development of,
194disorders: addictive disorders (
see addictive disorders;
attention deficit hyperactivity disorder [ADHD]);
alcohol use disorder,
31; bipolar disorder,
79,
80; externalizing psychiatric disorders,
151,
152; internalizing psychiatric disorders,
151–52; movement disorders,
119; obsessive-compulsive disorder,
119; posttraumatic stress disorder (PTSD),
124,
125; social anxiety disorder,
153; substance use disorders,
18,
26,
30,
153disorganized behaviors,
198,
243“Does Rejection Hurt?”
133dopamine,
61,
62,
64–66,
70,
175–76,
177,
179,
183,
222,
229,
230dorsal visual stream,
118down-regulated reactivity, to negative stimuli,
247drug development, as gamble,
131drug effects, as interaction between molecules and brains they hit,
168drug industry, addiction treatments as at the bottom of priorities of,
131drug problems, as frequently occurring in people who have alcohol problems,
28drugs: addictive properties of as influenced by characteristics of user,
164;cost of damage inflicted by,
5; percent of users who develop destructive relationship with,
20; rewarding properties of over time,
68; war on,
9,
15drug seeking: brain structures and,
119;as coordinated movement,
70; as diagnostic criterion of addiction,
61;mesolimbic dopamine circuits as promoting incentive motivation leading to,
68; as not determined by dopamine systems alone,
74; reinstatement of,
108–9,
112; role of stress and negative emotions in,
55; similarity to ICSS,
61; triggers for,
127drug use: availability as major determinant of,
164; as escalating over time,
25Dutch, and opium trade,
166
effectiveness, compared to efficacy,
280n2effects: alcohol, multifaceted effects of,
183; dampening effects,
183,
184;drug effects, as interaction between molecules and brains they hit,
168; mind-altering drug effects,
19; motor-stimulating effects,
183,
184; pleasurable effects,
67,
83,
168;psychotropic drug effects,
19,
85,
165;sleep-inducing effects,
184Egypt, distilled spirits,
180electroencephalogram (EEG),
46empathy, importance of provider’s expression of,
194equal environment assumption (EEA),
277n8ethyl alcohol (ethanol),
179European Medicines Agency,
110evidence-based medicine,
186,
188–89,
197,
199,
204,
208,
237,
238,
240,
245,
249extended residential care,
14externalizing psychiatric disorders,
151,
152extinction–reinstatement model,
115–16Extracting the Stone of Madness (Bosch),
190
extrahypothalamic brain regions,
129,
130
feelings, ability of medical professionals to tune in to those of patients,
42,
46,
48fishbowl reinforcement,
203formaldehyde fluorescence method,
270n10frontal lobes,
94,
95,
97,
99,
102,
109,
117,
118,
122,
133,
183frontocortical brain circuitry,
195,
200full-scale treatment trials/studies,
126–27functional magnetic resonance imaging (fMRI),
46,
66,
117,
132,
247functional variation,
157future: discounting (value of future outcome),
92,
97,
98; human ability to plan for,
95,
98; hypothetical futures,
54,
94,
95,
96; memory of the,
53
GABA-receptor finding,
160,
161gamma-amino butyric acid (GABA),
181–83gender: and brain reward system activation,
221; and heritability of alcoholism,
147gene(s): definition,
156; number of in human genome,
157genome association studies,
160genome-wide association studies,
159goals, pursuit of,
24,
25,
27,
58,
67,
71,
134,
192,
193,
227,
230,
237Golden Crescent, and opium trade,
166Golden Triangle, and opium trade,
166Goldstein, Dora (Dody),
86Graduate School of Addiction Studies (Hazelden),
249,
252Greeks, ancient: alcohol use,
180; on genetics in alcoholism risk,
139; wine and,
18gut-wrenching experience,
7,
133
Handbook of Alcoholism Treatment Approaches (Hester and Miller),
187
happiness, pursuit of,
57–74hazardous alcohol use, as category,
27heroin: buprenorphine as treatment for addiction to,
9; dependence on as deadliest of addictions,
171; harm to self and others inflicted by as less than that of alcohol,
16; methadone maintenance as managing addiction to,
78,
206–11; minority of users as developing particularly destructive relationship with,
20; naltrexone as treatment for addiction to,
213–14; as prototypical addictive opiate,
167;relapse,
171; self-administration of in animals,
85; sequence of events after taking,
169; as treatment for morphine addiction,
167; treatment for overdose of,
69.
See also buprenorphine;
methadone treatment/maintenancehigher power, as resource,
234,
240homelessness progression,
32Hospital Farm (Willmar Hospital Farm for Inebriates),
242Human Genome Project,
161humanism, coming together with science,
46,
192–93hypothalamic factors,
128hypothalamic-pituitary-adrenal (HPA) axis,
128,
129,
130
ignorance, substance use as not a consequence of,
19impulsivity: relation of to addiction,
98–103,
152; serotonergic function as critical for,
162incentive sensitization theory,
68,
70–72individual environment,
146insertion–deletion polymorphism,
157insurance coverage, as lacking,
28intent-to-treat analysis,
237internalizing psychiatric disorders,
151–52International Classification of Diseases and Health Problems (ICD-10),
21
International Cochrane Collaboration,
237–38intoxication,
14,
19,
34,
66,
83–86,
90,
169,
170,
178,
184,
204,
226intracranial self-stimulation (ICSS),
60,
61involuntary admissions,
13,
14
Joint Commission on Accreditation of Healthcare Organizations,
262
kappa-opioid receptor,
69Karolinska Institute,
32,
33,
64Khantzian, Edward J.,
78,
197
labeling, of conditions/groups of conditions,
22,
26language, common, need for,
22long-term-access model,
86long-term disease management approach,
198
Mark O. Hatfield Clinical Research Hospital,
232medial temporal lobe,
118medications: anticraving medications,
8,
193,
252; antipsychotic medications,
62; antistress mechanisms/ medications,
55,
81,
84,
131,
231; detox medications,
34; as lacking for addiction to cocaine, amphetamine, other stimulants, and cannabis,
229–30; prescription opioid analgesics,
214;skepticism against use of for treatment of addictive disorders,
247; that hold potential for treatment of alcoholism,
227–29.
See also acamprosate;
baclofen;
buprenorphine;
disulfiram;
methadone treatment/maintenance;
naltrexone;
topiramatemesencephalon (midbrain),
62mesolimbic dopamine neurons,
65Mesopotamia, alcohol use in,
180messenger RNA (mRNA),
156methadone treatment/maintenance,
7,
9,
78,
171,
186,
187,
203,
207–10,
214,
215,
257,
263methamphetamine (meth),
178,
179methodological behaviorism,
58Miller, William (Bill),
187mind-altering drug effects,
19missing heritability,
160,
161models/modeling: extinction–reinstatement model,
115–16; long-term-access model,
86; medical model,
7,
44; Minnesota Model,
244,
245,
252,
253; modeling of social rejection,
132–33; relapse model,
108; structural equation modeling,
146; twelve-step programs/model,
235,
238,
245,
247,
252moment, being in the,
204Montreal Neurological Institute,
95morphine: events after taking,
169;heroin as cure for addiction to,
167; as injection,
167; manufacture of,
166;numbers of addicts in U.S. by end of nineteenth century,
167; and pain suppression,
169,
170; for postoperative pain,
168; as prototypical medical opiate,
167; speculation that body may have a receptor for,
69morphine (
Principium somniferum), extraction of,
166morphine-like substances (opioids),
68,
70,
164,
208morphine-receptor (μ–),
69motivation: to consume alcohol,
88,
126; to get off drugs,
191–92; to obtain drugs,
19,
24,
30,
134; opponent process theory of,
82–83; to seek food,
67motivational enhancement therapy,
194motivational processes,
59motor-stimulating effects,
183,
184multiphasic approach (to treatment),
244
naltrexone,
8,
36,
85,
109,
110,
130,
138,
139,
170,
186,
187,
213–14,
218–22,
225,
245,
248,
252,
257,
261National Association of Addiction Treatment Providers,
247National Epidemiological Survey on Alcohol and Related Conditions (NESARC),
27National Institute on Alcohol Abuse and Alcoholism (NIAAA),
8,
27,
66,
147,
159,
161National Institute on Drug Abuse (NIDA),
64,
109,
120,
201neurokinin1 (NK1) receptor blocker,
246neurons, number of,
50–51nicotine addiction, gene association for,
160nicotine replacement therapy,
216nicotinic acetylcholine receptor,
216Nirenberg, Marshall W.,
156nonsynonymous (amino acid coding),
156nucleus accumbens,
62,
64,
65,
66,
70,
73,
94,
117,
118,
119,
121,
183number needed to treat (NNT),
187
obsessive-compulsive disorder,
119office-based treatment,
211once an addict, always an addict,
109once an alcoholic, always an alcoholic,
233online recovery management tools,
254“On the Hygienic and Medicinal Properties of Coca and on Nervous Nourishment in General” (Montegazza),
173opinion-based medicine,
188,
208opium poppy (
Papaver somniferum),
19,
164opponent process rule,
178opponent process theory of motivation,
82–83,
84outcome expectations, as needing to reflect chronic relapsing nature of disease,
40outpatient-based treatments,
261
Papaver somniferum (opium poppy),
19
Parsons, Loren (Larry),
223partial nicotinic agonist,
216Passages Addiction Cure Center,
185,
263patch clamp electrophysiology,
268n2persecutory delusions,
177pharmaceutical industry: on addiction medications,
212; attention of to addictions,
5; needing involvement of for new treatments,
213,
229.
See also drug industryPhiladelphia VA Medical Center,
218Phoenicians, opium use of,
165physiological dependence,
21policy makers, challenges in dealing with,
189positive reinforcement,
79posttraumatic stress disorder (PTSD),
124,
125preexisting conditions,
79prescription opioid analgesics,
214priming-induced reinstatement,
112priming-induced relapse,
111proteins, as business end of genome,
157psychiatric addiction unit, description of,
3–4psychiatry: different schools of thought in,
47; as marriage of science and humanism,
46psychodynamic psychotherapy,
190psychological dependence,
21psychological relapse prevention treatment,
125psychomotor stimulant theory of addiction,
63psychosocial treatment,
208–10psychotropic drug effects,
19,
85,
165
quality-adjusted life years,
16
rats, experiments on,
22–24,
51,
54,
59–63,
65–66,
68,
70,
84–88,
94,
101,
115,
122,
130,
131–32,
225reactivity: cue-reactivity,
120; down-regulated reactivity, to negative stimuli,
247; to psychological stress,
52; restored reactivity, to pleasant images,
247readiness for change,
192reason: in contrast to emotions,
94; role of,
53receptors: delta-opioid receptor,
69,
70; dopamine receptors,
62,
73,
82,
177,
230; endorphin receptors,
207;GABA receptors,
182; kappa-opioid receptor,
69; mu-opioid receptors,
69,
70,
170,
207,
210–11,
220,
222,
223; nicotinic acetylcholine receptor,
216;opioid receptors (non-specific),
69,
208,
212,
213recruitment: of addiction medicine practitioners,
260; for treatment studies,
226reinforcement: fishbowl reinforcement,
203; negative reinforcement,
79,
85,
154,
184; positive reinforcement,
79;voucher-based reinforcement therapy,
203relapse: behavioral relapse prevention treatments,
199; context-induced relapse,
121; cue-induced relapse,
115,
116,
122; deep brain stimulation and,
119; as expected element of addiction,
12; as not having to be a disaster,
12;prevention of as central objective for treatments,
197; priming-induced relapse,
111; psychological relapse prevention treatment,
125; setting the scene for,
63; simplified view of,
52; steps to dealing with,
200–204;stress-induced relapse,
127,
129–31;triggers for,
88,
108,
109,
115,
120,
121,
130,
132,
190relapse-prevention techniques,
257,
261relaxed social inhibitions,
20Research Society on Alcoholism,
81research studies, design of,
110resistance, importance of provider rolling with what appears to be,
194–95restored reactivity, to pleasant images,
247reward deficit syndrome,
73,
82,
184reward prediction error signal,
67reward prediction error,
64Rockefeller University,
208,
220Russia, mushroom use in,
18–19
science, coming together with humanism,
46,
192–93science of addiction: as emerging,
8;as needing to be brought together with treatment world,
8,
259,
260; as window on brain functions,
7Scripps Research Institute,
33,
81,
223self-administration,
22–23,
62,
63,
65,
70,
85,
88,
101,
108,
109,
115,
225self-report measures,
116Serteurner, Friedrich,
166,
173signals: glutamate signals,
182; pleasure signal,
67; reward prediction error signal,
67single nucleotide polymorphism (SNP),
157,
159,
160Skinner, Burrhus Frederick (B. F.),
58sleep-inducing effects,
184Smith, Robert Holbrook (Dr. Bob),
232social anxiety disorder,
153social factors, as stressors,
132social rejection, modeling of,
132–33social relationships,
132Society for Neuroscience,
109,
176spiritual focus (of AA),
235,
240standardized mortality rate (SMR),
265n1Stockholm Adoption Study,
143–45stress: cravings in response to,
88; as major trigger of relapse,
88,
120,
190;as making people drink and take drugs,
87; role of in relapse,
125,
126,
129,
131,
132stress-induced craving,
126,
130structural equation modeling,
146studies/trials: adoption studies,
142–45;challenges facing studies of treatment,
186–87; cocaine user study,
117;COMBINE study,
219,
225; costs of,
228–29; evaluating efficacy of treatment,
186; full-scale treatment trials/studies,
126–27; genome association studies,
160; genome-wide association studies,
159; randomized controlled trials,
186,
190,
219,
235–36; recruitment for,
226; research studies, design of,
110; Stockholm Adoption Study,
143–45; twin studies,
145–48,
150substance dependence syndrome,
21,
26,
27Sumerians, opium use of,
165supremacism of rationality,
93syndromes: Asian flush syndrome,
159,
218; dependence syndrome,
18,
21,
22,
27,
30; discontinuation syndrome,
30;reward deficit syndrome,
73,
82,
184;substance dependence syndrome,
21,
26,
27synonymous (amino acid coding),
156
targeted use (of medications),
110Thebes, opium use in,
165theories: incentive sensitization theory,
68,
70–71,
72; opponent process theory of motivation,
82–83,
84;psychomotor stimulant theory of addiction,
63; self-medication theory,
77–80,
197; theory of emotions,
197;theory of mind,
43therapies: behavioral therapy,
199; cognitive-behavioral therapy,
194,
199,
204,
257; cue exposure therapy (CET),
120,
202; motivational enhancement therapy,
194; nicotine replacement therapy,
216; psychodynamic psychotherapy,
190; psychotherapy,
190,
194; talk therapy,
13; third-wave cognitive-behavioral therapies,
204; voucher-based reinforcement therapy,
203third-wave cognitive-behavioral therapies,
204Thorndyke, Edward Lee,
58thyrotropin releasing factor (TRF),
128thyrotropin releasing hormone (TRH),
128transcranial magnetic stimulation (TMS),
119treatment: access to as lacking,
28;antihypertensive treatment,
27,
30;behavioral treatments,
119–10,
186,
188,
205; challenges facing studies of,
186–87; costs of,
188,
261; costs of research studies on,
228–29; difficulty in getting funding for,
253; for hypertension as example of potential for addiction,
39–40; importance of building an alliance in,
45; importance of long-term disease management approaches,
198; importance of patient taking responsibility in,
45;importance of relationship building in,
191–94; importance of working together in,
45; as an industry,
9; key elements of effective ones,
197; medical treatments seen as not appropriate or effective,
39; mega-buck industry based on provision of,
189; Minnesota Model,
244,
245,
252,
253; most commonly offered ones,
188; multiphasic approach to,
244; as needing to be tailored to individual,
191,
226; as needing to focus on continuing care and disease management,
40; office-based treatment,
211; outpatient-based treatments,
261; psychosocial treatment,
208–10; recruitment for studies of,
226; resources as scarce for,
9; roles of various professionals in,
21; studies evaluating efficacy of,
186; systematic, structured approaches as ones that work best,
191treatment-seeking alcoholics,
29twelve-step facilitation,
232
University of Pennsylvania Treatment Research Center,
36,
110,
114,
221,
248U.S. Court of Appeals for the Second Circuit, ruling on atheist drunk driver’s constitutional rights,
242U.S. Second Continental Congress,
57U.S. Supreme Court, on sentencing juveniles,
97
ventral visual stream,
118vignettes: Carlos,
89–92,
96,
103; Eric,
12–15,
24,
27,
28; Ivy League–educated lawyer,
231–32,
240–41; Lars,
111–12;Peter,
104–7,
111; track and field athlete,
135–39,
227voucher-based reinforcement therapy,
203
whole-genome association approach,
161Willmar Hospital Farm for Inebriates (Hospital Farm),
242withdrawal,
3,
21,
25,
30,
32,
76,
78,
79,
80,
83,
86,
87,
104,
106,
114,
115,
169–71,
178,
184,
198,
207,
225,
226,
232within-systems adaptations,
82