The Anatomy of Addiction (23 page)

A book of this scope requires assistance from many.

First, I would like to give special thanks to the team that facilitated its publication, including Greg Ptacek for captaining the book from proposal to final manuscript; my literary agent Harvey Klinger for navigating the project through the ever-changing shoals of today's publishing world; and publisher John Duff for providing the book safe harbor at Penguin Random House.

I also to wish to thank my colleagues at University of Southern California Keck School of Medicine, who have allowed me to create and teach an addiction medicine curriculum that I hope will serve as a model for medical school nationwide. I thank, too, my students for constantly challenging convention and questioning the status quo.

Also deserving praise is the staff at my clinic and our residential facility Inspire Malibu. Their professionalism, expertise,
and dedication are hallmarks of our evidence-based treatment program.

Finally, I wish to sincerely thank the patients who allowed me to share their stories here within these pages. To borrow a timeless inscription from ancient Egypt, may they
ankh wedja seneb
: “Live long, be healthy, and prosper.”

The page numbers in this index refer to the printed version of this book. The link provided will take you to the beginning of that print page. You may need to scroll forward from that location to find the corresponding reference on your e-reader.

abstinence,
xii
,
xiii
,
8
,
21
,
28
–29,
44
–45,
58
,
110
,
122
,
142
,
180
,
210

medications and,
13
,
28
–29

acamprosate (Campral),
98
,
115

acid flashbacks,
164

addict, use of term,
212

addiction:

brain and,
see
brain

as chronic disease,
xii
,
3
–4,
14
–16,
21
,
24
,
25
,
47
–67,
69
,
94
,
95
,
103
–4,
133
,
138
–40,
172
,
208
–9,
212

definitions of,
64
–67,
138
,
140
–41,
208

dependence vs.,
138
–39

disorders co-occurring with,
see
dual diagnoses

extreme cases of,
143
–44

family history of,
140
,
183
,
187
–89

films about,
15
–16

genes and,
see
genetics

medical consequences of,
see
medical consequences of addiction

myths of,
see
myths of addiction

prevention of,
xiii
,
178
–79,
183
,
213

psychiatric realities in,
145
–48

public opinion about,
4
–5

science of,
see
science of addiction

statistics on,
4
,
172
–75

treatment of,
see
treatment

in U.S., history of,
4
–7

Addiction
,
143

addicts,
20
–22,
157
–58

accidental,
135

changing face of,
134
–35,
137

criminalization of,
see
criminalization

older,
see
older addicts

physicians,
154
–55

rock bottom and,
43
–44

stigmatization of,
4
–5,
8
,
9
,
20
–23,
88
,
140
,
213

teens,
see
teenagers and young adults

adolescence:

brain in,
58
,
81
,
175
–76,
190
–92

see also
teenagers and young adults

Affordable Care Act (ACA),
15
,
153
,
209
–10,
211
,
212

age,
see
older addicts

Agency for Healthcare Research and Quality,
43

alcohol,
34
,
51
,
138

bars and nightclubs and,
179
–80

binge drinking and,
72
,
164
,
176
,
183
,
190

brain and,
18
,
59
–61

danger of,
6

deaths from,
ix
–x,
6
,
33
,
36
,
59
,
70
–71,
207

dependence on,
20
,
60
–61

detoxification from,
124
–26

as different from other drugs,
30
–33

driving and,
21
,
60
,
176
,
177
,
179
–80

economic cost of,
x

genetics and,
60
,
61

Joanne's experience with,
47
–49,
50
,
63

legal age for drinking,
177
–78

legality and social acceptability of,
6
,
30
,
36
,
59
,
70
–71

length of average addiction to,
176

marijuana and,
81
,
85

mixing other drugs with,
71

physical damage from,
59
,
71
–72,
74

pregnancy and,
see
pregnancy

Prohibition and,
6
,
114

psychiatric problems and,
73
–74

tolerance to,
60

withdrawal from,
17
–19

alcoholics,
157
–58

anxiety and depression in,
164

Freud on,
32
–33

rock bottom and,
43
–44

suicide and,
70
,
74

Alcoholics Anonymous (AA),
7
,
8
–10,
20
–21,
24
,
28
–29,
44
–45,
92
,
95
,
130
,
145
,
151
,
172
,
210

films and,
15

Hoffman and,
5

medications and,
13
,
160
–61

problems with,
12
–13,
21

rock bottom and,
43
–44

sponsors in,
13

structure and philosophy of,
9
,
12
,
210

see also
12
-step programs

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism
(Big Book),
9
–10

alcoholism:

first use of term,
31

medications for treatment of,
98
,
115
–16

alcohol withdrawal delirium,
124
–26

Alertec,
117
,
128

Alexander, Josh,
209

Alzheimer's disease,
77
,
93

American Academy of Pain Medicine,
64

American Board of Addiction Medicine,
131
,
132
,
152

American Medical Association (AMA),
xi
,
3
,
131
,
138

American Pain Society,
64

American Psychiatric Association,
3
,
138

American Society for Reproductive Medicine,
82

American Society of Addiction Medicine (ASAM),
64
,
66
–67,
96
,
120
,
140
–41

Patient Placement Criteria of,
141

amphetamines,
77
,
78

analgesics,
20
,
34
,
37

see also
opiates and opioids

anger,
106
–11

Antabuse (disulfiram),
116
,
144
–45,
170

anxiety,
164

anxiolytic drugs,
20
,
34

see also
benzodiazepines

arthritis,
93
,
172

assessment for treatment,
95
–96

asthma,
1
,
14
,
23
,
30
,
31
,
43
,
49
,
51
,
93
,
95
,
133
,
208

Ativan,
125

Atlantic,
41
,
209

attention deficit disorder (ADD),
105
–6,
121
–22

attention deficit hyperactivity disorder (ADHD),
168

autism spectrum disorder,
168

baclofen,
115

Baltimore Buprenorphine Initiative,
24

barbiturates,
85
–86

bars and nightclubs,
179
–80

Basketball Diaries, The,
16

bath salts,
114
,
136

Bayer,
31

behavior,
61
–63

brain and,
51
,
57
,
58

cognitive behavioral therapy and,
48
,
50
,
99
,
166

modification of,
57

behavior, intoxicated,
106
–12

anger,
106
–11

compulsion,
31
,
33
,
57
,
110
–11

obsession,
110
,
111
–12

Bell, Chris,
209

belladonna,
28
,
161

benzodiazepines,
85
–86,
105
,
120
,
125
–26

detoxification from,
128
–29

Betty Ford Center,
11
,
12
,
24

binge drinking,
72
,
164
,
176
,
183
,
190

biomedical therapy,
94
,
95
,
97
–98

see also
medications for addiction

bipolar disorder,
29
,
33
,
43
,
105
,
145
,
159
–60,
208

birth defects,
70
,
194

see also
fetal alcohol syndrome, fetal alcohol spectrum disorders

Boston Medical and Surgical Journal,
31

brain,
xii
,
3
–4,
23
,
49
–58,
95
,
97
,
100
,
107
,
110
–12,
133
–34,
147
,
206
,
212

alcohol and,
18
,
59
–61

behavior and,
51
,
57
,
58

blood flow to,
192

development of,
102
,
190

executive function in,
58
,
145
,
197

hippocampus in,
191

imaging technology and,
3
,
29
,
50
,
53
,
167
,
191
–92,
197
,
206

limbic lobe in,
188

marijuana and,
81

neurotransmitters in,
see
neurotransmitters

“new normal” and,
56

prefrontal cortex in,
176
,
191

receptors in,
33
,
39
,
52
,
56
,
60
,
81

relapse and,
134

reward system of,
44
–45,
49
,
50
,
56
,
57
,
60
,
61
,
63
,
103
,
111
,
112
,
146
,
167
,
188
,
212

specific addictions and,
37

stress system of,
60
–61

of teenagers,
58
,
81
,
175
–76,
190
–92

white matter in,
191
–92

brain damage,
18
,
58
,
72
–74,
175
,
188
,
189
,
192

from fetal alcohol syndrome,
194
–98

breathing,
39

buprenorphine (Subutex),
117
,
144
,
204

Baltimore Buprenorphine Initiative,
24

buprenorphine + naloxone (Suboxone),
13
–15,
24
,
45
–46,
97
–98,
104
–5,
112
–13,
117
,
144
,
205
,
209

bupropion,
116
,
127
–28

Burkman, Lani J.,
82

Business of Recovery, The,
209

caffeine,
161

CAMA,
see
Columbia University Center on Addiction and Substance Abuse

Campbell, Joanne,
47
–49,
50
,
63

Campral (acamprosate),
98
,
115

Canadian Paediatric Society,
195

cannabis,
see
marijuana

celebrities,
x
–xi,
77
,
85
,
86
,
123

Philip Seymour Hoffman,
x
–xi,
5
,
56
,
76
,
123

Celexa,
166

Centers for Disease Control and Prevention (CDC),
37
–38,
136

Chaplin, Charlie,
119
–20

Cherkis, Jason,
46

chlordiazepoxide,
125

choices,
140

Cigna,
210

citalopram,
166

Clean and Sober,
16

clonazepam,
125

clonidine,
98
,
120

cocaine,
20
,
33
–34,
49
,
51
,
77
,
105
,
136
,
138
–39

additives in,
78

alcohol and,
71

coke bugs and,
78
–79