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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 72, Substance Use Disorders: Alcohol, CNS Depressants, Stimulants, Nicotine.



  • imageGlobally, more than 3 million people, predominantly males, died in 2016 from alcohol consumption, which represents 1 in 20 deaths.

  • imageStudies have identified genotypic and functional phenotypic variants that either serve to protect patients or predispose them toward alcohol dependence.

  • imageExcept at very high and very low blood concentrations, the metabolism of alcohol is considered to follow zero-order pharmacokinetics, and this has important implications for the time course in which alcohol can exert its effects.

  • imageDisulfiram, naltrexone, and acamprosate are FDA-approved drug therapies for the treatment of alcohol dependence. The clinical utility of these agents to improve sustained abstinence and reduce heavy drinking remains controversial.

  • imageTobacco is the number one preventable cause of death in the United States.

  • imageIt is recommended that clinicians ask all adults about tobacco use, advise on how to stop using tobacco products, and provide pharmacotherapy and behavioral treatment options to aid in smoking cessation.

  • imageAll forms of nicotine replacement therapy are effective in reducing the amount smoked and achieving abstinence.

  • imageVarenicline may be more efficacious than all other single nicotine replacement therapies (NRTs) (except for similar efficacy to the nicotine patch) and is approved by the FDA for up to 6 months of maintenance therapy.

  • imageCaffeinism is the term coined to describe the clinical syndrome produced by acute or chronic overuse of caffeine. As many as one in five adults consume doses of caffeine generally considered large enough to cause clinical symptoms.

  • imageEnergy drinks continue to be popular particularly among adolescents and emerging adults. Concerns have been raised regarding the safety of these products.


Preclass Engaged Learning Activity

Alcohol Use Disorder

Watch this 5-minute video entitled, “Brief intervention: Steve,” which provides an example of an outpatient clinician making an intervention on a patient with an alcohol problem. This video is useful to enhance student understanding of how the AUDIT tool can help collect patient information during a patient interview and how motivational interviewing can effectively help patients realize their problem and develop a plan of action.

  1. The patient in the video scored in Zone 2 of the AUDIT questionnaire. Describe how you would interpret those results.

  2. Motivational interviewing is a counseling approach where clinicians use a patient-centered stance in combination with techniques to help patients explore and resolve their own mixed feelings about changing unhealthy behaviors.

    • The principles of motivational interviewing include:

      • Expressing empathy—building rapport and engaging the patient by seeking to understand his/her perspective

      • Developing discrepancy—determining the patient’s perception of how well current behaviors match desired behaviors

      • Rolling with resistance—letting the patient make the arguments for change instead of the clinician arguing for change

      • Supporting self-efficacy—using reflective statements to restate the patient’s ...

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