Richard K. Ries MD FAPA FASAM - The Asam Principles of Addiction Medicine

THE ASAM

Principles of Addiction Medicine

FIFTH EDITION

THE ASAM

Principles of Addiction Medicine

FIFTH EDITION

SENIOR EDITOR

Richard K. Ries, MD, FAPA, FASAM

Professor of Psychiatry

Director, Division of Addictions

Department of Psychiatry and Behavioral Sciences

University of Washington;

Medical Director, Harborview Addictions and Rehabilitation Psychiatry Programs

Harborview Medical Center

Seattle, Washington

ASSOCIATE EDITORS

David A. Fiellin, MD

Professor of Medicine, Investigative Medicine and Public Health

Yale University School of Medicine

New Haven, Connecticut

Shannon C. Miller, MD, FASAM, DFAPA

Medical Director, Dual Diagnosis & Outpatient Clinics

Program Director, VA Fellowship in Addiction Medicine Research

VAMC, Cincinnati;

Co-Program Director, Addiction Psychiatry Fellowship

Associate Director of Education & Training

Associate Director, Addiction Sciences Division

Professor of Clinical Psychiatry, Affiliated

Department of Psychiatry & Behavioral Neuroscience

University of Cincinnati College of Medicine

Cincinnati, Ohio;

Co-Editor, Journal of Addiction Medicine

American Society of Addiction Medicine

Richard Saitz, MD, MPH, FACP, FASAM

Chairman, Department of Community Health Sciences (CHS)

Professor of Community Health Sciences & Medicine

Boston University Schools of Public Health and Medicine

Clinical Addiction Research and Education (CARE) Unit

Section of General Internal Medicine

Boston Medical Center

Boston, Massachusetts

Acquisitions Editor: Julie Goolsby

Senior Product Development Editor: Kristina Oberle

Development Editor: Grace Caputo

Marketing Manager: Stephanie Manzo

Production Project Manager: David Saltzberg

Senior Manufacturing Manager: Beth Welsh

Design Coordinator: Stephen Druding

Production Services: SPi Global

Copyright 2014 by (ASAM)

Fourth edition, 2009 by (ASAM)

Third Edition, 2003 by (ASAM)

Second Edition, 1998 by (ASAM)

First Edition, 1994 by (ASAM)

All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.

Printed in China

Library of Congress Cataloging-in-Publication Data

Principles of addiction medicine / senior editor, Richard K. Ries ; associate editors, David A. Fiellin, Shannon C. Miller, Richard Saitz. Fifth edition.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4511-7357-4

I. Ries, Richard, editor of compilation. II. Miller, Shannon C., editor of compilation. III. Saitz, Richard., editor of compilation. IV. Fiellin, David A., editor of compilation.

[DNLM: 1. Substance-Related Disorderstherapy. 2. Behavior, Addictive. 3. Substance-Related Disorderscomplications. 4. Substance-Related Disordersdiagnosis. WM 270]

RC564.15

362.29dc23

2013036483

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice.

LWW.com

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Dedicated to all people whose lives have been affected by addiction and related conditions and to those who care for them based on respect and the best science available.

Section Editors

Peter Banys, MD, MSc

Clinical Professor of Psychiatry

University of California at San Francisco (UCSF)

San Francisco, California;

Technical Advisor

Addiction and Psychiatry Treatment

FHI 360 Vietnam

Wilson M. Compton, MD, MPE

Deputy Director

National Institute on Drug Abuse

National Institutes of Health

U.S. Department of Health and Human Services

Bethesda, Maryland

Edward C. Covington, MD

Director

Neurological Center for Pain

Cleveland Clinic Foundation

Cleveland, Ohio

John A. Dani, PhD

Professor

Department of Neuroscience

Perelman School of Medicine

University of Pennsylvania

Philadelphia, Pennsylvania

Robert L. DuPont, MD, FASAM

President

Institute for Behavior and Health, Inc

Rockville, Maryland;

Clinical Professor of Psychiatry

Georgetown University Medical School

Washington, District of Columbia;

Executive Vice President

Bensinger DuPont & Associates;

Chairman

Prescription Drug Research Center

Chicago, Illinois

Marc Galanter, MD, FASAM

Professor of Psychiatry

Department of Psychiatry

NYU School of Medicine

New York, New York

R. Jeffrey Goldsmith, MD

Professor of Clinical Psychiatry

Department of Psychiatry and Clinical Neuroscience

University of Cincinnati College of Medicine;

Staff Psychiatrist

Mental Health Care Line

Cincinnati VA Medical Center

Cincinnati, Ohio

Adam J. Gordon, MD, MPH, FACP, FASFM

Associate Professor of Medicine

Advisory Dean

University of Pittsburgh School of Medicine

VA Center for Health Equity Research and Promotion

VISN 4 Mental Illness Research, Education, and Clinical Center

VA Pittsburgh Healthcare System

Pittsburgh, Pennsylvania

David A. Gorelick, MD, PhD

Professor of Psychiatry

Maryland Psychiatric Research Center

Department of Psychiatry

University of Maryland School of Medicine

Baltimore, Maryland

John R. Knight, MD

Associate Professor of Pediatrics

Harvard Medical School;

Director

Center for Adolescent Substance Abuse Research

Boston Childrens Hospital;

Chair

Developmental Medicine

Boston Childrens Hospital

Boston, Massachusetts

Thomas R. Kosten, MD, PhD

Waggoner Chair and Professor of Psychiatry, Neuroscience, Pharmacology, and Immunology

Baylor College of Medicine

Houston, Texas