Community Treatment of Drug Misuse: More Than Methadone 2nd Edition

Methadone has been used successfully as a substitution agent for heroin dependency for more than 30 years. As a result of its success, other effective methods of treatment have been neglected. Established as a key text on all treatment options for drug misusers, Community Treatment of Drug Misuse: More Than Methadone has been highly praised for its practical orientation based on a solid research background. For the second edition, all the main evidence-based and more pragmatic treatment approaches are reviewed, not only in the management of opiate dependence, but across the range of drugs. It focuses extensively on developments in the last few years as a result of policy initiatives and research findings, including coverage of buprenorphine treatment, the systematic treatment of cocaine abuse and work with special patient groups. This is of direct relevance to medical as well as non-medical practitioners undertaking clinical work in the addictions. Cover......Page 1 Half-title......Page 4 Title......Page 6 Copyright......Page 7 Contents......Page 8 Preface and acknowledgements......Page 10 Introduction: community treatment in context......Page 14 Drug misuse as a social problem......Page 15 Risk factors for drug misuse......Page 16 The role of treatment......Page 17 Inpatient treatment......Page 19 General observations......Page 20 Introduction......Page 23 Formal methadone maintenance programmes......Page 25 Other long-term methadone prescribing......Page 26 Specific treatment or heroin substitute?......Page 27 A classic example of different approaches......Page 29 Case history......Page 30 Individual treatment or public health policy?......Page 31 Effectiveness of methadone......Page 32 Associated counselling......Page 36 Treatment contracts......Page 37 Methods......Page 38 Safety issues......Page 39 Additional medication......Page 41 Adverse effects......Page 42 Case history......Page 44 Injectable ampoules......Page 45 Case history......Page 47 Introduction......Page 48 Diamorphine......Page 49 Case history......Page 52 Morphine......Page 53 Case history......Page 54 Issues in prescribing euphoriant opioids......Page 55 Rationale......Page 56 Use......Page 57 Some study evidence......Page 58 Particular practicalities......Page 59 Dihydrocodeine......Page 60 Amphetamines......Page 61 Case history......Page 64 Benzodiazepines......Page 65 Detoxification from benzodiazepine misuse......Page 66 Case history......Page 67 Prescribing benzodiazepines to opioid substitution patients......Page 68 Alternatives to benzodiazepines......Page 71 Assessment, preparation and level of support required......Page 73 Method 2 – Lofexidine plus symptomatic medication......Page 75 Method 3 – Dihydrocodeine plus symptomatic medication......Page 76 Clonidine......Page 77 Suitability as a detoxification medication......Page 78 Evidence from studies......Page 80 Starting dose......Page 81 Rate of reduction......Page 82 Partial detoxifications......Page 83 Buprenorphine......Page 84 Inpatient treatment......Page 86 Naltrexone......Page 87 Case history......Page 90 General methods......Page 91 Other observations......Page 93 Introduction......Page 94 Cocaine......Page 95 Pharmacological treatments......Page 96 Nonpharmacological treatments......Page 97 Practical management......Page 98 Case history......Page 99 Cocaine misuse by opioid substitution patients......Page 100 Amphetamine......Page 103 Methylenedioxymethamphetamine (MDMA, ‘ecstasy’)......Page 105 Methamphetamine (‘crystal meth’, ‘ice’)......Page 107 Benzodiazepines......Page 108 Hallucinogens......Page 110 Volatile substances......Page 111 Cannabis......Page 112 Alcohol......Page 114 Case history......Page 116 Brief therapies......Page 117 Other medications......Page 118 Historical development......Page 119 Changes in emphasis......Page 120 Some further developments......Page 123 Organization within teams......Page 124 Drug counselling......Page 125 Levels of interest......Page 127 Effectiveness......Page 129 Some characteristics of primary care treatment......Page 130 Introduction......Page 133 Mental disorders in drug misusers......Page 134 Personality disorder......Page 135 Drug-induced psychosis......Page 139 Drug misuse in the severely mentally ill......Page 141 Principles of treatment......Page 143 Ultra-specialist treatment units......Page 144 Other treatment models......Page 145 The general hospital......Page 147 Treatment in pregnancy......Page 148 Young drug users......Page 149 Pain management......Page 151 HIV and hepatitis......Page 152 Treatment in prisons......Page 154 Lomotil (2.5mg tablets) (reduces diarrhoea)......Page 156 Dihydrocodeine (30 mg tablets)......Page 157 Glossary......Page 159 References......Page 162 Index......Page 188 Methadone: the main treatment for the main presenting drug problem More than methadone? The case for other substitute drugs Achieving detoxification and abstinence Treatment of non-opiate misuse Community drug services Treatment of drug misuse in primary care Dual diagnosis : drug misuse and psychiatric disorder Liaison work and special patient groups.

combines Highly Practical Approach With Strong Research Base To Provide Comprehensive Guide To Treatment And Service Provision.