Drug abuse and addiction are common in clinical practice. Often they interfere with patient treatment or require an alternative approach. Drug Abuse and Addiction in Medical Illness: Causes, Consequences, and Treatment is a major contribution to the literature, a gold standard title offering a comprehensive range of topics for those who care for patients with addiction, conduct research in this area, or simply have an interest in the field. Offering state-of-the-art information for all those working with drug abusing or addicted patients, or for those interested in this topic from other research perspectives, the volume is a first of its kind book -- rich, comprehensive, yet focused, addressing the needs of the very active theoretical, basic, and clinical research in the field. Comprised of 46 chapters organized in four sections and developed by the leading international experts, Drug Abuse and Addiction in Medical Illness: Causes, Consequences, and Treatment covers virtually every core, as well as contemporary, topic on addiction, from the established theories to the most modern research and development in the field. Enhancing the educational value of the volume, every chapter includes an abstract and two boxes summarizing learning objectives and directions for future research. Drug Abuse and Addiction in Medical Illness: Causes, Consequences, and Treatment discusses the topic in a authoritative, systematic manner and is an indispensable reference for all clinicians and researchers interested in this rapidly changing field.

From the President of the Research Society on Alcoholism The sixteenth volume of Recent Developments in Alcoholism contains the latest information on the field of alcoholism treatment research. This scholarly volume includes comprehensive reviews of the methodologies available to evaluate treatment outcome, state-of-the art psychosocial interventions, and recent advances in pharmacological adjuncts to treatment that are currently available and those on the brink of application. Other sections of the book address special issues in the treatment of alcohol dependence, including the treatment of the adolescents and other unique populations, the management of tobacco dependence, and the role of spirituality in recovery, among others. The clinician will find these reviews an important resource for learning about e- dence based treatments for alcoholism, and the researcher will find the synt- sis of recent developments informative and forward looking. The research agenda for the future rests soundly on the progress to date and additional advances in the treatment of alcoholism can be predicted in the near future. Stephanie O'Malley, Ph. D. President, Research Society on Alcoholism xi Preface From the President of the American Society of Addiction Medicine This excellent volume presents investigations covering a wide spectrum of scientific issues. It is also evident that many of these articles have clinical s- nificance, ranging from assessments of disorder, monitoring clinical progress, and behavioral and pharmacological interventions.

From the President of the Research Society on Alcoholism On behalf of the Research Society on Alcoholism, I am pleased to introduce this thirteenth volume of Recent Developments in Alcoholism about alcohol and violence. Current concepts are presented in well-organized sections that - cus on epidemiology, neurobiology, psychology, and family issues. It is - coming increasingly clear that age, gender, socioeconomic circumstances, and genetics affect aggressive behavior and vulnerability to alcoholism. This v- ume contains up-to-date discussions of these issues. Indeed, the information presented here will help all alcohol researchers to identify biological and social factors that contribute to the comorbidity of alcoholism and aggression. The editors and associate editors should be congratulated for bringing toge- er such important information. This volume will be a valuable resource for investigators and therapists alike. Ivan Diamond M. D. , Ph. D. President, Research Society on Alcoholism From the President of the American Society of Addiction Medicine The American Society of Addiction Medicine is honored to continue its - sponsorship with the Research Society on Alcoholism of Recent Developmen ts in Alcoholism. The topic of alcohol and violence is a particularly timely one, given the growing number of studies that are examining the relationship between the two. These studies are consistent with the hypothesis that al- hol can increase aggression and contribute to both domestic and criminal violence. Intoxicating blood levels of alcohol have been found to be especially prevalent in those injured in fights and assaults.

From the President of the Research Society on Alcoholism In recent years the alcohol research field has matured and is attracting a substantial number of eager and technically sophisticated researchers. There is a feeling of excitement and premonitions of breakthroughs as more and more of alcohol's actions are being detailed. I, however, have at times been sobered by the perception that the lure of parsimonious explanations and the appeal of studying easily demonstrable effects obscure the critical issues re garding alcohol abuse and alcoholism. Central questions regarding (1) the reinforcing properties of ethanol and other factors responsible for inappro priate consumption of alcohol, (2) the heterogenous characteristics (both bi ologic and sociologic) of the alcoholic population, and (3) the differential predisposition of individuals to alcohol-induced medical problems needed to be vigorously pursued. Researchers who used animals as models for the human condition needed to become more intimately aware of the variety of factors that are of importance in the development of alcoholism in an indi vidual. On the other hand, researchers studying humans needed to attempt to more clearly define and categorize diagnostic criteria and characteristics of various alcoholic populations. Such categorization and continued character ization of alcoholism allows not only for a framework of concepts within which proper animal models for studies of biologic mechanisms can be de veloped but also allows for consideration of the most apt treatment approaches."

From the President of the Research Society on Alcoholism On behalf of the Research Society on Alcoholism, I am pleased to introduce this 14th volume of Recent Developments in Alcoholism about the consequences of alcoholism. Current concepts are presented in well-organized sections that focus on the medical, neuropsychiatric, economic, and biobehavioral con- quences of alcoholism. This volume contains up-to-date discussions of these issues. The editors and associate editors should be congratulated for bringing together such important information. This volume will be a valuable resource for investigators and therapists alike. Ivan Diamond M.D., Ph.D. President, Research Society on Alcoholism From the President of the American Society of Addiction Medicine On behalf of the American Society of Addiction Medicine, I am pleased to announce that our society once again will cosponsor Recent Developments in Alcoholism. This volume addresses the issues of age, gender, socioeconomy, and behaviors as they relate to alcohol research and the disease of alcoholism. The medical consequences of alcoholism are ably edited by Dr. Charles L- ber, while the neuropsychiatric consequences of alcoholism are addressed by Drs. Gottheil. This volume is rounded out with the in-depth discussion of the economic consequences of alcoholism, edited by Dr. Fuller, and an inter- tional perspective on the behavioral consequences of alcoholism, edited by Dr. Paredes.

Volume eight brings up to date several areas important to physicians who care for people with addictive disorders. It deals with the topic of combined alcohol and other drug dependences, and includes chapters on definition of the dependence syndrome, social deviancy and alcohol dependence, and biolo

From the President of the American Society of Addiction Medicine Recent Developments in Alcoholism (Volume 10) is a major contribution to the literature of addiction medicine. This volume, 'ru.cohol and Cocaine: Similarities and Differences," contains an impressive collection of chapters from the basic research, epidemiological, and clinical research perspectives, as well as articles that address the relative policy issues and clinical application and patient care concerns. It also sends a message to those who would still distinguish between alcohol and drugs, or legal and illegal drugs. In the research laboratory, in the intentions and behavior of the user, and by the clinician, such distinctions have never been upheld. The first section, "Clinical Pathology," includes chapters on the role of alcohol in cocaine dependence, dual-diagnosis empirical and developmental humanistic approaches, and on neuroendocrine and catecholamine levels in humans during administration and withdrawal of cocaine and alcohol, emer gency room evaluation of cocaine-associated neuropsychiatric disorders, and clinical and pharmacological interactions of alcohol and cocaine. These chap ters, written by authors who are preeminent in their fields, offer a broad perspective to both the researcher and the clinician on relevant issues in clinical pathology. ."

'Each topic is covered in sufficient depth, currency, and clarity to be of value to the neophyte and the seasoned researcher/clinician.' --- American Journal of Psychiatry, from a review of a previous volume The current volume addresses a range of issues across this diverse field, including the effects on society, physiology and biochemistry, clinical pathology, and trends in treatment.

It was once taken for granted that peer-assisted groups such as Alcoholics Anonymous had no "real" value in recovery from addiction. More recently, evidence-based medicine is recognizing a spiritual component in healing-especially when it comes to addiction. The newest edition of Recent Developments in Alcoholism reflects this change by focusing on the 12-step model of recovery as well as mindfulness meditation and other spiritually oriented activity. More than thirty contributors bring together historical background, research findings, and clinical wisdom to analyze the compatibility of professional treatment and nonprofessional support, day-to-day concepts of relapse prevention, the value of community building in recovery, and much more. Among the topics covered: (1) How and why 12-step groups work. (2) The impact of the spiritual on mainstream treatment. (3) The impact of AA on other nonprofessional recovery programs. (4) AA outcomes for special populations. (5) Facilitating involvement in 12-step programs. (6) Methods for measuring religiousness and spirituality in alcohol research. Whether one is referring clients to 12-step programs or seeking to better understand the process, this is a unique resource for clinicians and social workers. Developmental psychologists, too, will find Volume 18-Research on Alcoholics Anonymous and Spirituality in Addiction Recovery a worthy successor to the series.

From the President of the Research Society on Alcoholism In the last decade research concerning the causes and consequences of alcohol abuse and alcoholism has come of age. We have witnessed a plethora of sci entific findings that have shed light on some of the actions of alcohol at the molecular level. Interesting new data have been forthcoming on the complexi ties of the development of tolerance to alcohol. It is becoming increasingly appropriate to consider that tolerance to alcohol involves biological as well as psychological factors. New scientific insights have been gained concerning the treatment of with drawal as well as the presence of persistent withdrawal signs that may possibly be involved with relapse. More recently, new and compelling data indicating that alcoholism is a common familial disorder have appeared. Clinical studies indicate that alcoholism is a heterogeneous disorder with multiformity in clin ical symptomatology and genetic heterogeneity. The heterogeneity of the clin ical features and the heritability of the predisposing factors of alcoholism are currently under vigorous scientific investigation. In the past several years sophisticated psychosocial studies have provided fundamental information on subjects at high risk for alcoholism. Psychosocial and biological studies of families including alcoholics and subjects at high risk are likely to bring new insights to our understanding of etiological factors. Moreover, as a result of these studies we stand to develop better prevention initiatives and treatment approaches."

Evidence-based medicine is recognizing a spiritual component in healing especially when it comes to alcohol addiction. This book brings together more than thirty contributors and reflects this change by focusing on the 12-step model of recovery.

Alcohol continues to be the substance of choice for today s youth, leading to serious physical, psychological, and social consequences. Alcohol Problems in Adolescents and Young Adults ably addresses this growing trend. The latest entry in the Recent Developments in Alcoholism series, it comprehensively presents a wide-ranging clinical picture of teen drinking - epidemiology, neurobiology, behavioral phenomena, diagnostic and assessment issues, prevention and treatment data - in a developmental context. Fifty expert contributors display the scientific rigor, practical wisdom, and nuanced analysis that readers have come to expect from previous volumes.

Among the subjects studied in depth:

- Initiation of alcohol use/abuse

- Risk and protective factors for alcohol dependence

- High-risk adolescent populations

- Drinking habits of college students

- Long-range consequences of teenage drinking

- Family-, school-, and community-based prevention programs

- Treatment of comorbid substance and psychiatric disorders

Clinicians, researchers, and policy makers will find this a bedrock source of evidence-based knowledge, whether one s goal is choosing an age-appropriate assessment tool for eighth graders, preventing drinking among high school students, or understanding the alcohol-friendliness of campus culture. Here is a critical resource for all professionals dedicated to helping youngsters grow up sober.

"

From the President of the Research Society on Alcoholism In recent years, increasingly convincing evidence in support of a biobehavioral conceptual model of the etiology of alcoholism has emerged. In this model, the disorder is perceived as arising from the interaction of geneticlbiological vulnerability and psychosocial risk. Drinking, or alcohol-seeking, is a metric trait. Alcoholism, which is a state of abnormally intense alcohol-seeking be havior that, over time, leads to the alcohol dependence syndrome, lies at the extreme, high end of this quantitative measure. Metric traits are influenced by multiple genes; the extent of genetic loading of biological risk for alcoholism would be different in different individuals. Added to this kind of variability is the wide range of options for exposure to the psychosocial risk factors of heavy drinking provided by modern society. Further, environmental prov ocation also changes when life events change. It is not surprising, therefore, from the combination of the kinds of genetic and environmental variability described above that there is a wide array of patterns of expression of the disorder alcoholism, referred to by some as "alcoholisms. " In the search for understanding of underlying mechanisms and rational bases for potential therapy, it is important to focus our attention on the final common pathway of this disorder, alcohol-seeking behavior. This series, ever since its beginning in 1983, has been sensitive to the complexities of the interaction between biological and psychosocial risk factors in alcoholism."

'Solid, plausible, accurate and loaded with pertinent and highly referenced information regarding clinical and basic research in alcholism among women and ethnic groups...an essential text in the libraries of academicians, teachers, clinicians, researchers, and policy makers. The quality and scope of the work are groundbreaking, and it is convenient to have it all in one source.' -American Journal of Psychiatry Volume 12 highlights the remarkable evolution of alcoholism research during the last few years, focusing on gender in alcohol actions and consequences.

Why do people join cults? How do cults exert such a strong influence over their members' beliefs and even their appearance? These and other questions about the operation of cult groups are answered in this unique book. The psychological forces that enable cults to exert their intense influence are analysed in detail and with many examples. These forces include social cohesiveness, which has its parallels in the ties that bind family members together; shared beliefs, which set the groups' standards for behaviour; and altered consciousness, which can lead to a rapid change in the attitudes of recruits and members. For this second edition, Galanter has added three new chapters on cult developments of the 1990s -- the Branch Davidians, Aum Shinrikyo, and Heaven's Gate. The books also features 32 new photographs.

Not just for lawyers, these illuminating histories of popular law-related expressions will delight anyone fascinated by words, by history, or by law and law enforcement Law-related words and phrases abound in our everyday language, often without our being aware of their origins or their particular legal significance: boilerplate, jailbait, pound of flesh, rainmaker, the third degree. This insightful and entertaining book reveals the unknown stories behind familiar legal expressions that come from sources as diverse as Shakespeare, vaudeville, and Dr. Seuss. Separate entries for each expression follow no prescribed formula but instead focus on the most interesting, enlightening, and surprising aspects of the words and their evolution. Popular myths and misunderstandings are explored and exploded, and the entries are augmented with historical images and humorous sidebars. Lively and unexpected, Lawtalk will draw a diverse array of readers with its abundance of linguistic, legal, historical, and cultural information. Those readers should be forewarned: upon finishing one entry, there is an irresistible temptation to turn to another, and yet another . . .

Spirituality has emerged as a prominent theme in contemporary culture. It is seen in issues as diverse as Eastern philosophies and religious awakenings; its psychological impact is apparent in alternative medicine, Alcoholics Anonymous, and meditation. In their own ways, each of these has helped people get relief from the problems psychiatrists often treat. But the mental health profession has generally ignored these isues, focusing on specific target symptoms, from anxiety to heavy drinking. Their efforts rely increasingy on medications and brief therapies as they succumb to the chilling influence of managed care. This raises an important question: Can the spiritual and professional, two perspectives that seem different, be reconciled? This book is designed to provide an answer to this question. It draws on recent findings in psychology, neuroscience, and innovative therapies to understand how people in America and worldwide express their spiritual needs. It then shows how the mentally ill, substance abusers, and people troubled by a sense that something is missing in their lives can be helped by developing a sense of personal meaning, while still benefitting from contemporary therapy and medications. Finally, it examines shortcomings in both the biomedical and spiritually-oriented approaches. The book draws on clinical experience and recent research studies, including the author's work over thirty years. This is enhanced by case studies drawn from patients, mental health professionals, the lay public, and even cult members. All this is brought together to create a vivid understanding of how mental health treatment can be made more effective by giving meaning to people's lives.

From the President of the Research Society on Alcoholism In the last decade research concerning the causes and consequences of alcohol abuse and alcoholism has come of age. We have witnessed a plethora of sci entific findings that have shed light on some of the actions of alcohol at the molecular level. Interesting new data have been forthcoming on the complexi ties of the development of tolerance to alcohol. It is becoming increasingly appropriate to consider that tolerance to alcohol involves biological as well as psychological factors. New scientific insights have been gained concerning the treatment of with drawal as well as the presence of persistent withdrawal signs that may possibly be involved with relapse. More recently, new and compelling data indicating that alcoholism is a common familial disorder have appeared. Clinical studies indicate that alcoholism is a heterogeneous disorder with multiformity in clin ical symptomatology and genetic heterogeneity. The heterogeneity of the clin ical features and the heritability of the predisposing factors of alcoholism are currently under vigorous scientific investigation. In the past several years sophisticated psychosocial studies have provided fundamental information on subjects at high risk for alcoholism. Psychosocial and biological studies of families including alcoholics and subjects at high risk are likely to bring new insights to our understanding of etiological factors. Moreover, as a result of these studies we stand to develop better prevention initiatives and treatment approaches.

From the President of the American Society of Addiction Medicine Recent Developments in Alcoholism (Volume 10) is a major contribution to the literature of addiction medicine. This volume, 'ru.cohol and Cocaine: Similarities and Differences," contains an impressive collection of chapters from the basic research, epidemiological, and clinical research perspectives, as well as articles that address the relative policy issues and clinical application and patient care concerns. It also sends a message to those who would still distinguish between alcohol and drugs, or legal and illegal drugs. In the research laboratory, in the intentions and behavior of the user, and by the clinician, such distinctions have never been upheld. The first section, "Clinical Pathology," includes chapters on the role of alcohol in cocaine dependence, dual-diagnosis empirical and developmental humanistic approaches, and on neuroendocrine and catecholamine levels in humans during administration and withdrawal of cocaine and alcohol, emer gency room evaluation of cocaine-associated neuropsychiatric disorders, and clinical and pharmacological interactions of alcohol and cocaine. These chap ters, written by authors who are preeminent in their fields, offer a broad perspective to both the researcher and the clinician on relevant issues in clinical pathology. .

From the President of the Research Society on Alcoholism In recent years, increasingly convincing evidence in support of a biobehavioral conceptual model of the etiology of alcoholism has emerged. In this model, the disorder is perceived as arising from the interaction of geneticlbiological vulnerability and psychosocial risk. Drinking, or alcohol-seeking, is a metric trait. Alcoholism, which is a state of abnormally intense alcohol-seeking be havior that, over time, leads to the alcohol dependence syndrome, lies at the extreme, high end of this quantitative measure. Metric traits are influenced by multiple genes; the extent of genetic loading of biological risk for alcoholism would be different in different individuals. Added to this kind of variability is the wide range of options for exposure to the psychosocial risk factors of heavy drinking provided by modern society. Further, environmental prov ocation also changes when life events change. It is not surprising, therefore, from the combination of the kinds of genetic and environmental variability described above that there is a wide array of patterns of expression of the disorder alcoholism, referred to by some as "alcoholisms. " In the search for understanding of underlying mechanisms and rational bases for potential therapy, it is important to focus our attention on the final common pathway of this disorder, alcohol-seeking behavior. This series, ever since its beginning in 1983, has been sensitive to the complexities of the interaction between biological and psychosocial risk factors in alcoholism.

From the President ofthe Research Society onAlcoholism - On behalf of the Research Society on Alcoholism I welcome the important contri bution that Volume 15 of this excellent series on Recent Developments in Alcoh- ism brings to our field. It is not enough for our scientists to develop effective and efficient methods to identify and treat alcohol abuse and alcohol dependence; the availability of these services is often limited and it is certainly nonexistent for the early problem drinker. In nineteen outstanding chapters, Volume 15 deals with organizational issues concerning access to and delivery of substance abuse treatment and the role of managed care. Several chapters deal with economic issues, cost-benefits, and - nancing of these services. Lastly, five address recent treatment outcome studies. Thus, this volume will be of great value to both scientists and practitioners. The Editor and Associate Editors are congratulated for this conceptual and organi- tional accomplishment. Yedy Israel, Ph.D.

'Each topic is covered in sufficient depth, currency, and clarity to be of value to the neophyte and the seasoned researcher/clinician.' --- American Journal of Psychiatry, from a review of a previous volume The current volume addresses a range of issues across this diverse field, including the effects on society, physiology and biochemistry, clinical pathology, and trends in treatment.