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Community Treatment of Drug Misuse : More than Methadone - Nicholas Seivewright

Community Treatment of Drug Misuse

More than Methadone

Hardcover

Published: 4th November 1999
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Treatment for drug misuse has been dominated in recent years by the use of methadone as a substitution agent in heroin dependency. This approach has had considerable success, but as a result other treatment options have been neglected. This book draws on the author's direct clinical experience and makes use of international research findings to provide a comprehensive and detailed guide to service provision and treatment for drug misuse, including methadone and alternative opiate substitutes, detoxification methods, naltrexone and relapse prevention, and possible approaches with non-opiate users. There is a particular emphasis on social factors in drug misuse and dependency, and the consequent treatment issues and practical difficulties, and case studies are used throughout. Combining a highly practical approach with a strong research base, this book will be an essential resource for psychiatrists and other professionals involved in the management of drug misuse.

' ... a well-written and stimulating book by an author whose opinions are informed by evidence and considerable experience in treating drug users. It is honest in acknowledging the difficult issues faced by practitioners and these are well illustrated in the case histories that show the mixed results often achieve in the treatment of substance misuse.' The Lancet ' ... well thought out, informative and non-partisan ... Good use is made of case histories ... This book will prove to be invaluable to clinicians and policy makers both old and new to the field. For the latter particularly, this book provides the opportunity to rethink and fine tune theoretical and practical underpinnings and identify new and more effective ways forward.' Drug Link '... a comprehensive, up-to-date and pragmatic account of treatment options for drug misusers. ... I would commend it as a worthwhile and practical friend who will provide reliable, relevant and understandable advice for any workers in this field, where guidance so frequently seems inaccessible or insufficient.' Health Bulletin 'This concise text presents a candid discussion of the strengths and weakness of treatments for a variety of substance use disorders, including opioid dependence, from a clinical, research and policy perspective.' Addiction 2001 'The book combines a highly practical approach with scientific rigour, beginning from the position that the drug treatment scene has become so dominated by methadone substitution treatment that other treatment endeavours are being overlooked ... a must read for all dedicated alcohol and drug clinicians ... I would particularly recommend it to all psychiatrists and psychiatric trainees.' Doug Sellman, Australia and New Zealand Journal of Psychiatry 'The clinical dilemmas which are discussed within the book have a very real resonance with everyday clinical practice. It is obvious that Dr Seivewright deals with these dilemmas on a daily basis, not just as an academic, but as a worker at the coalface of addictions service delivery ... I strongly recommend this book, both to the experienced drug worker, as a thought provoking and challenging book which should inform their practices, and also to less experienced practitioners, as a general introduction to the field.' Chris Daly, International Journal of Geriatric Psychiatry 'This book provides psychiatrists, GPs, nursing staff and forensic practitioners, as well as specialist drug workers both new to the field and experienced, with a practical, yet readable guide to assist their understanding of drug treatment and inform service provision.' Debbie McQueirns, The British Journal of Forensic Practice

Forewordp. ix
Preface and acknowledgementsp. xi
Introduction: community treatment in contextp. 1
Drug misuse as a social problemp. 3
Risk factors for drug misusep. 4
The role of treatmentp. 6
Inpatient and residential treatmentp. 8
Summaryp. 13
Treatments
Methadone maintenance: a medical treatment for social reasons?p. 17
Introductionp. 17
The term 'methadone maintenance'p. 18
Formal methadone maintenance programmesp. 19
Other long-term methadone prescribingp. 20
The nature of methadone treatmentp. 22
Effectiveness of methadonep. 29
Associated counsellingp. 33
Practical managementp. 35
Other forms of methadone, including injectablep. 43
Summaryp. 46
More than methadone? The case for other substitute drugsp. 49
Introductionp. 49
Diamorphinep. 50
Dipipanone (Diconal)p. 55
Cyclimorphinep. 56
Morphinep. 57
Issues in prescribing euphoriant opioidsp. 59
Levo-alpha-acetylmethadol (LAAM)p. 61
Buprenorphinep. 62
Dihydrocodeinep. 64
Amphetaminesp. 65
Benzodiazepinesp. 70
Summaryp. 79
Achieving detoxification and abstinencep. 82
Introductionp. 82
Quick detoxifications from heroinp. 83
Clonidinep. 88
Methadonep. 88
Treatment in pregnancyp. 99
Buprenorphinep. 103
Inpatient treatmentp. 104
Other influences on choice of detoxifcation methodp. 106
Treatment of minor opioid misusep. 106
Relapse preventionp. 107
Summaryp. 115
Treatment of nonopiate misusep. 118
Introductionp. 118
Cocainep. 119
Amphetaminep. 128
Methylenedioxymethamphetamine (MDMA, 'ecstasy')p. 132
Benzodiazepinesp. 135
Cyclizinep. 138
Hallucinogensp. 139
Steroidsp. 140
Volatile substancesp. 140
Cannabisp. 141
Alcoholp. 143
Nicotinep. 145
Summaryp. 148
Providing clinical services
Community drug servicesp. 153
Introductionp. 153
Historical developmentp. 153
Changes in emphasisp. 155
Local provisionp. 158
Drug counsellingp. 164
Summaryp. 165
Treatment of drug misuse in primary carep. 167
Introductionp. 167
Problemsp. 167
Levels of interestp. 169
Positive treatment approachesp. 171
Summaryp. 174
Balancing security and accessibilityp. 176
Introductionp. 176
The changing policy picturep. 177
Drug misuse deathsp. 180
Implications for servicesp. 184
Summaryp. 188
Dual diagnosis--drug misuse and psychiatric disorderp. 190
Introductionp. 190
Mental disorders in drug misusersp. 191
Drug misuse in the severely mentally illp. 196
Summaryp. 202
Epilogue Future directionsp. 204
The scope of treatmentp. 204
Opioid substitutionp. 205
Security of treatmentp. 206
Evidence-based practicep. 207
Stimulant misusep. 208
Hepatitis Cp. 209
Detoxificationp. 210
Child protectionp. 210
Protocols for quick detoxification from heroinp. 212
Opioid equivalent dosagesp. 215
Glossaryp. 216
Referencesp. 219
Indexp. 241
Table of Contents provided by Syndetics. All Rights Reserved.

ISBN: 9780521590914
ISBN-10: 0521590914
Audience: Professional
Format: Hardcover
Language: English
Number Of Pages: 259
Published: 4th November 1999
Publisher: Cambridge University Press
Country of Publication: GB
Dimensions (cm): 22.8 x 15.2  x 1.8
Weight (kg): 0.56