During the last few centuries, and particularly in recent decades, problems result- ing from the excessive use of drugs and alcohol have spread virtually as an epidemic to every country in the world and to almost every community. Abuse of alcohol and drugs is related to numerous other health problems, such as the spread of acquired immune deficiency syndrome (AIDS) on all continents. Health and social services today cannot afford to ignore this crisis since it affects all levels of society and manifests itself in diverse health and social problems. In recent years, the World Health Organization has received numerous requests for training material for physicians in this field. This manual therefore meets an urgent need. The availability of new data and the dearth of suitable textbooks have made its preparation mandatory. The influence of sociocultural factors on drug dependence and alcohol- related problems-on their cause, development, and consequences as well as on their treatment and prevention-has been taken into account in the preparation of this manual in order to ensure that its usefulness is not limited to one country or region. It has been prepared primarily for the teaching of physicians and medical students, although much of it is relevant to the training of nurses, midwives, health educators, primary-care workers, medical social workers, counselors, and psychologists. In fact, suggestions have been included for adapting the manual for use in the training of such varied groups of students.

Table of Contents:
1. Introduction and Definitions.- 1. Background.- 2. Organization and Structure of the Manual.- 3. Purpose and Aim.- 4. Methodology-How Was This Manual Produced?.- 5. Special Aspects of This Volume.- 6. Definitions and Terminology.- References.- I. Teaching Approaches.- 2. Guidelines for Teaching and Training.- 1. Introduction.- 2. Curriculum Design.- 2.1. Statement of the Problem: Sociomedical Crisis Today.- 2.2. Approaches to Curriculum Design.- 2.3. Problems in Curriculum Development.- 3. Curriculum Development.- 3.1. Instructional Tasks.- 3.2. Faculty and Students.- 3.3. Course Content.- 3.4. Timing and Location of Teaching Drug Dependence.- 3.5. Education Methods.- 3.6. Local Resources.- 4. Teaching Diagnostic Skills in Drug Dependence.- 4.1. Importance of Early Diagnosis.- 4.2. The Clinical Context.- 4.3. Elements of the Physician-Patient Relationship.- 4.4. Teaching the Interview Process.- 4.5. Teaching Assessment and Diagnostic Skills.- 5. Attitude Assessment and Change.- 5.1. Attitudinal Problems.- 5.2. Origins and Determinants of Attitudes.- 5.3. Attitudinal Measurement and Educational Goals.- 5.4. Teaching for Attitude Change.- 5.5. The Process of Attitude Change.- 6. Evaluation and Testing.- 6.1. Examination of the Student.- 6.2. Teacher Evaluation.- 7. Summary.- References.- Further Reading.- II. The Problem and its Assessment.- 3. Historical Background.- 1. Introduction.- 2. Drugs and Their Uses.- 2.1. Drug Discovery, Production, and Spread.- 2.2. Drug Uses.- 2.3. Routes of Administration.- 3. Evolution of Drug-Related Problems.- 3.1. Changing Concepts and Awareness.- 3.2. Transportation and Commerce.- 3.3. Technical Development.- 4. Social Controls over Drug Use and Abuse.- 4.1. Restrictions on Production and Import.- 4.2. Control of Therapeutic Drugs through Prescribing Laws.- 4.3. Taxation and Revenue.- 4.4. Prohibition.- 4.5. Other Sociocultural Approaches.- 4.6. Provision of Treatment Facilities.- 5. Drug-Abuse Problems Today.- References.- Further Reading.- 4. Epidemiological Assessment.- 1. Introduction.- 2. Sources of Data.- 2.1. Sales and Seizures.- 2.2. Registers.- 2.3. Surveys of Special Populations.- 2.4. Surveys of General Populations.- 2.5. Death Rates.- 2.6. Other Indicators.- 2.7. The Capture-Recapture Model.- 2.8. Special Aspects of Alcohol-Related Problems.- 2.9. Drug-Dependence Complications as Epidemiological Indicators.- 3. Extent of Drug Dependence Today.- 3.1. Opium and Heroin.- 3.2. Coca Leaf and Cocaine.- 3.3. Cannabis.- 3.4. Sedatives.- 3.5. Amphetamines.- 3.6. Alcohol.- 4. Demographic Variables.- 4.1. Gender.- 4.2. Age.- 4.3. Social and Other Variables.- 5. Current Global Trends in Drug Abuse and Dependence and Future Trends.- 5.1. Current Trends According to the Type of Drug Abuse and Dependence.- 5.2. Current Overall Global Trends.- 5.3. Populations at Risk.- 5.4. Future Trends in Drug Abuse and Dependence.- 5.5. Implications for Public Health.- 6. Morbidity and Mortality Related to Drug Abuse.- 7. Drug Dependence and Implications for Human Reproduction.- References.- Further Reading.- 5. Etiological Factors.- 1. Introduction.- 2. Host Factors.- 2.1. Genetic Factors.- 2.2. Neurotransmitters and Enzymes.- 2.3. Psychological Factors.- 3. Agent.- 3.1. Availability.- 3.2. Cost.- 3.3. Laws and Regulations.- 4. Environmental Factors.- 4.1. Culture.- 4.2. Family Influence.- 4.3. Peers.- 4.4. Secondary Reinforcers.- References.- Further Reading.- 6. Natural Course and Psychosocial Manifestations.- 1. Introduction.- 2. Course of Drug Dependence.- 2.1. Manifestations of the Course.- 2.2. Factors Affecting Course.- 3. Natural Course According to Type of Drug.- 3.1. Opioids.- 3.2. Alcohol.- 3.3. Cocaine.- 3.4. Tobacco.- 3.5. Cannabis.- 3.6. Polydrug Abuse.- 4. Psychosocial Consequences of Drug Dependence.- 4.1. Special Aspects.- 4.2. The Family.- 4.3. Types of Families in Drug Dependence.- 4.4. Family Health Problems.- 5. Recovery.- 5.1. Chronology of Recovery.- 5.2. Psychological Concomitants of Recovery.- 5.3. Social Concomitants of Recovery.- 5.4. Clinical and Demographic Considerations.- 5.5. Recovery According to Different Drugs of Abuse.- References.- III. Pharmacological Factors.- 7. Pharmacology of Dependence-Producing Drugs.- 1. Introduction.- 2. Metabolism and the Drugs of Abuse.- 2.1. Absorption.- 2.2. Drug Distribution.- 2.3. Termination of Drug Actions.- 2.4. Quantitative Characterization of Drug Action.- 2.5. Special Pharmacological Issues Related to Drugs of Dependence.- 3. Opioids.- 3.1. Sources of Opioids and Their Antagonists.- 3.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 3.3. Effects.- 3.4. Tolerance, Dependence, Abstinence Syndrome.- 4. Alcohol (Ethanol, Ethyl Alcohol).- 4.1. Forms of Alcohol.- 4.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 4.3. Effects.- 4.4. Tolerance, Dependence, Abstinence Syndrome.- 5. Sedatives (Including Benzodiazepines).- 5.1. Forms of the Drugs.- 5.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 5.3. Effects.- 5.4. Tolerance, Dependence, Abstinence Syndrome.- 6. Amphetamines.- 6.1. Administration, Absorption, Distribution, Metabolism, Excretion.- 6.2. Effects.- 6.3. Tolerance, Dependence, Abstinence Syndrome.- 7. Cocaine.- 7.1. Forms of the Drug.- 7.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 7.3. Effects.- 7.4. Tolerance, Dependence, Abstinence Syndrome.- 8. Cannabis.- 8.1. Forms of the Drug.- 8.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 8.3. Effects.- 9. Tobacco/Nicotine.- 9.1. Forms of the Drug.- 9.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 9.3. Effects.- 9.4. Tolerance, Dependence, Abstinence Syndrome.- 10. Caffeine.- 10.1. Forms of the Drug.- 10.2. Administration, Absorption, Distribution, Metabolism, Excretion.- 10.3. Effects.- 10.4. Tolerance, Dependence, Abstinence Syndrome.- 11. Volatile Solvents-Inhalants.- 11.1. Aromatic Hydrocarbons.- 11.2. Aliphatic Hydrocarbons.- 11.3. Halogenated Solvents and Propellants.- 11.4. Trichlorinated Solvents.- 11.5. Inhalational Anesthetic Drugs.- 11.6. Aliphatic Nitrites.- 12. Phencyclidine.- 12.1. Administration, Absorption, Distribution, Metabolism, Excretion.- 12.2. Effects.- 13. D-Lysergic Acid and Related Compounds.- 13.1. Indolylalkylamines.- 13.2. Phenylalkylamine Derivatives.- 14. Atropinelike Substances.- 15. Betel-Areca.- 16. Khat (Chat, Qat).- 17. Combined Drug Effects.- References.- Further Reading.- IV. Diagnosis and Management.- 8. Clinical Diagnosis and Assessment.- 1. Introduction.- 2. Background Factors.- 2.1. Interaction between the Physician, Patient, and Community.- 2.2. Reason for Consultation.- 3. History Taking.- 3.1. Content and Process of History Taking.- 3.2. Chief Complaint.- 3.3. Present Illness, Review of Systems, Family History, and Social History.- 3.4. Drug Use History.- 4. Physical Examination.- 5. Laboratory Testing and Screening.- 6. Self-Rating Scales.- 7. Collateral Informants and Family Assessment.- 8. Communicating the Diagnosis.- References.- Further Reading.- 9. Detoxification and Management of Medical Emergencies.- 1. Introduction.- 2. Intoxication.- 2.1. Acute Pathological Intoxication.- 2.2. Acute Anxiety, Panic Attack.- 2.3. Toxic Psychosis.- 2.4. Drug-Precipitated Psychosis.- 2.5. Special Problems Associated with Intoxication.- 2.6. General Treatment Measures.- 2.7. Specific Treatment Measures.- 3. Overdose.- 3.1. General Measures.- 3.2. Specific Measures.- 4. Withdrawal.- 4.1. Principles of Withdrawal Therapy.- 4.2. General Measures.- 4.3. Specific Measures.- 5. Other Acute Conditions.- 5.1. Wernicke-Korsakoff Encephalopathy.- 5.2. Management of Medical or Surgical Problems.- References.- Further Reading.- 10. Medical Complications.- 1. Introduction.- 2. Nonspecific Complications.- 2.1. Malnutrition.- 2.2. Infectious Disease.- 2.3. Trauma.- 2.4. Psychiatric Disorders.- 2.5. Psychosomatic Disorders.- 3. Mode of Administration.- 3.1. Ingestion.- 3.2. Chewing.- 3.3. Nasal Insufflation.- 3.4. Smoking.- 3.5. Parenteral Injection.- 4. Drug-Specific Complications.- 4.1. Opioids.- 4.2. Alcohol.- 4.3. Sedative-Hypnotics, Anxiolytics.- 4.4. Amphetamines.- 4.5. Cocaine.- 4.6. Hallucinogens.- 4.7. Phencyclidine.- 4.8. Cannabis.- 4.9. Nicotine/Tobacco.- 4.10. Caffeine.- 4.11. Volatile Inhalants.- 4.12. Designer Drugs.- References.- Further Reading.- 11. Psychosocial Management.- 1. Introduction.- 2. Principles of Psychosocial Treatment.- 2.1. Individual Assessment Prior to Treatment.- 2.2. Building a Therapeutic Alliance.- 2.3. Early Abstinence.- 2.4. Facilitating Recovery.- 2.5. Helpful Approaches for the Clinician.- 2.6. Phasing Therapeutic Priorities and Tasks.- 3. Individual Treatment Approaches.- 3.1. Physician-Patient Relationship.- 3.2. Behavior Therapy.- 3.3. Contingency Contracting (Contingency Management, Therapeutic Contracting).- 4. Family Treatments.- 4.1. Principles of Family Treatment.- 4.2. Treating Particular Family Types.- 5. Group Treatment.- 5.1. Psychodrama, Social Skills Learning.- 5.2. Group Psychotherapy.- 6. Inpatient and Residential Treatment.- 6.1. Indications for Inpatient or Residential Care.- 6.2. Hospital Units for Drug Dependence.- 6.3. Therapeutic Communities.- 6.4. Partial Care Residences.- 6.5. Emergency Service Centers (Detoxification Stations).- 7. Day, Evening, and Weekend Programs.- 8. Outpatient Follow-up Treatment.- 9. Religious Programs.- 10. Self-Help Groups.- 11. Multimodality Approach.- 12. Making an Effective Referral.- References.- Further Reading.- 12. Pharmacotherapy.- 1. Introduction.- 2. Principles in the Pharmacotherapy of Drug Dependence.- 3. Opioid Maintenance (Substitution Therapy).- 3.1. Methadone and Opium Maintenance.- 3.2. Withdrawing the Patient from Maintenance.- 3.3. Weak Opioid Drugs.- 4. Naltrexone Therapy.- 5. Disulfiram Therapy.- 6. Nicotine Maintenance (Substitution Therapy).- 7. Tricyclic Antidepressant Therapy.- 8. Electroacupuncture.- 9. Aversion Therapies.- 9.1. Electrical Aversion.- 9.2. Chemical Aversion.- References.- V. Public Health Approaches.- 13. Public Health Planning.- 1. Introduction.- 2. Drug Dependence from a Public Health Perspective.- 2.1. Nature and Extent of the Problem.- 2.2. Assessing Etiological Factors.- 2.3. Consequences for the Community.- 3. Public Health Approaches.- 3.1. Intervention: Policy.- 3.2. Intervention: Strategy.- 4. Program Planning, Development, and Management.- 4.1. Characteristics of Treatment Programs.- 4.2. Goal Setting and Treatment Objectives.- 4.3. Operation of the Program.- 4.4. Program Evaluation.- 4.5. Influence of Treatment on Clinical Outcome.- 4.6. Methodological Issues in Studying Outcome.- 4.7. Cost Benefit.- 4.8. Cost Effectiveness.- References.- Further Reading.- 14. Prevention.- 1. Introduction.- 2. Public Health Approaches.- 3. Role of Public Policy.- 3.1. Public Policy toward Drugs.- 3.2. Standard Control Policies.- 4. Classification of Prevention.- 5. Primary Prevention.- 5.1. Populations at Risk.- 5.2. Education.- 5.3. Strategies Utilizing the Agent.- 5.4. Strategies Utilizing Host Factors.- 5.5. Strategies Utilizing Environmental Factors.- 6. Secondary Prevention.- 6.1. Screening for Drug Dependence.- 6.2. Case Finding in the Clinical Setting.- 6.3. Prescribing to Prevent Dependence.- 6.4. Early Case Finding in Nonclinical Settings.- 7. Tertiary Prevention.- 7.1. Prevention of Medical Complications.- 7.2. Patient Registration and Community Surveillance.- References.