CLINICAL TEXTBOOK OF ADDICTIVE DISORDERS Clinical Textbook of Addictive Disorders THIRD EDITION Editedby RICHARD J. FRANCES SHELDON I. MILLER AVRAM H. MACK THE GUILFORD PRESS New York London ©2005TheGuilfordPress ADivisionofGuilfordPublications,Inc. 72SpringStreet,NewYork,NY10012 www.guilford.com Allrightsreserved Nopartofthisbookmaybereproduced,translated,storedinaretrievalsystem,or transmitted,inanyformorbyanymeans,electronic,mechanical,photocopying, microfilming,recording,orotherwise,withoutwrittenpermissionfromthePublisher. PrintedintheUnitedStatesofAmerica Thisbookisprintedonacid-freepaper. Lastdigitisprintnumber: 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Clinicaltextbookofaddictivedisorders/editedbyRichardJ.Frances,SheldonI. Miller,AvramH.Mack.—3rded. p.cm. Includesbibliographicalreferencesandindex. ISBN1-59385-174-X(hardcover) 1. Substanceabuse. 2. Alcoholism. I. Frances,RichardJ. II. Miller,SheldonI. III. Mack,AvramH. RC564.C552005 616.86—dc22 2004026092 About the Editors Richard J. Frances, MD,isClinicalProfessorintheDepartmentofPsychiatry atNewYorkUniversitySchoolofMedicineandDirectorofPublicandProfes- sional Education at Silver Hill Hospital in New Canaan, Connecticut. He is alsoinprivatepracticeinNewYorkCity.Dr.FranceswasformerPresidentand MedicalDirectoratSilverHillHospital;wasfoundingpresidentoftheAmeri- can Academy of Addiction Psychiatry; and helped found and chaired the CouncilofAddictionPsychiatryfortheAmericanPsychiatricAssociation.He istheauthorofseveralhundredarticlesandseveralbooks,andisonnumerous editorialboardsofjournals.Dr.Francesfrequentlylecturesonaddictionpsychi- atry and has appeared numerous times as a guest on Court TV. SheldonI.Miller,MD,istheLizzieGilmanProfessorofPsychiatryandformer Chairman of the Department of Psychiatry and Behavioral Sciences at North- westernUniversity.Duringhiscareer,hehasservedonmanyboardsandcom- mittees of many national and local organizations. Dr. Miller has authored or coauthored over 60 scientific articles, chapters, and books. He is Editor-in- ChiefoftheAmericanJournalonAddictionsandwasafounderoftheAmerican AcademyofAddictionPsychiatry.Dr.MillerisontheBoardofDirectorsofthe Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine. He also currently serves as Vice Chair of the American Psychiatric Association’s Council on Medical Education and Life- long Learning. Avram H. Mack, MD, is Assistant Professor of Psychiatry at the Institute of Psychiatry of the Medical University of South Carolina in Charleston. He is a graduate of the University of Michigan–Ann Arbor and of Cornell University v vi About the Editors MedicalCollege.Dr.Mackhasextensiveexperienceinorganizedmedicineand psychiatry.Hisotherareasofinterestinpsychiatryhaveincludeddevelopment, thepsychiatricpresentationofmedicaldisorders,andthehistoryofpsychiatric classification. As a child and forensic psychiatrist, he has treated or evaluated individuals with addictions in many different settings, including general inpa- tient, outpatient, correctional, juvenile justice, and community. Dr. Mack has lectured to medical groups, bar associations, patient groups, and other mental health professionals as well. Contributors Michelle C. Acosta, PhD, Department of Psychiatry, St. Luke’s–Roosevelt Hospital Center, New York, New York D. Andrew Baron, PhD, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania David A. Baron, DO, MSEd, Department of Psychiatry and Behavioral Medicine, Temple University, Philadelphia, Pennsylvania Steven H. Baron, PhD, Department of Social Sciences, Montgomery County Community College, Blue Bell, Pennsylvania Judith S. Beck, PhD, Beck Institute for Cognitive Therapy, Bala Cynwyd, Pennsylvania Sheila B. Blume, MD, Department of Psychiatry, State University of New York at Stony Brook School of Medicine, Stony Brook, New York Oscar G. Bukstein, MD, MPH, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania Alisa B. Busch, MD, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts; Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, Massachusetts Kathleen M. Carroll, PhD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut Ricardo Castañeda, MD, Department of Psychiatry, New York University School of Medicine, New York, New York Stephen L. Dilts, Jr., MD, MBA, Department of Psychiatry, Penn State College of Medicine, University Park, Pennsylvania; Department of Behavioral Health, WellSpan Health, York, Pennsylvania vii viii Contributors Stephen L. Dilts, MD, PhD, Department of Psychiatry, University of Colorado Health Sciences Center, Denver, Colorado Lance M. Dodes, MD, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts Caroline M. DuPont, MD, DuPont Clinical Research, Rockville, Maryland; Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland Robert L. DuPont, MD, Institute for Behavior and Health, Rockville, Maryland; Department of Psychiatry, Georgetown University, Washington, DC Richard J. Frances, MD, Silver Hill Hospital, New Canaan, Connecticut; Department of Psychiatry, New York University School of Medicine, New York, New York; private practice, New York, New York Hugo Franco, MD, Dual Diagnosis Unit, New York University Hospital, New York, New York; private practice, Eatontown, New Jersey John Franklin, MD, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Marc Galanter, MD, Department of Psychiatry, New York University School of Medicine, New York, New York Tony P. George, MD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut Jon E. Grant, JD, MD, Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island Deborah L. Haller, PhD, Department of Psychiatry, St. Luke’s–Roosevelt Hospital Center, New York, New York Francis Hayden, MD, Department of Psychiatry, New York University School of Medicine, New York, New York Anthony W. Heath, PhD, United Behavioral Health, Schaumburg, Illinois James M. Hill, PhD, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Norman Hymowitz, MD, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Jeffrey P. Kahn, MD, Department of Psychiatry, Weill Medical College of Cornell University, New York, New York Yifrah Kaminer, MD, Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut Cheryl Ann Kennedy, MD, Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Contributors ix Edward J. Khantzian, MD, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts Kenneth L. Kirsh, PhD, Symptom Management and Palliative Care Program, Markey Cancer Center, University of Kentucky, Lexington, Kentucky Herbert D. Kleber, MD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York Thomas R. Kosten, MD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut Petros Levounis, MD, The Addiction Institute of New York, St. Luke’s–Roosevelt Hospital Center, and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY Bruce S. Liese, PhD, Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas Marsha M. Linehan, PhD, Department of Psychology, University of Washington, Seattle, Washington David Lussier, MD, Division of Geriatric Medicine, Montreal General Hospital, McGill University, Montreal, Quebec, Canada Thomas R. Lynch, PhD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, and Department of Psychology, Duke University, Durham, North Carolina Avram H. Mack, MD, Institute of Psychiatry, Medical University of South Carolina, Charleston, South Carolina Marylinn Markarian, MD, FEGS Continuing Day Program, Brooklyn, New York Elinore F. McCance-Katz, MD, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia David McDowell, MD, Department of Psychiatry, Columbia University, New York, New York Sheldon I. Miller, MD, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Edgar P. Nace, MD, Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas Lisa M. Najavits, PhD, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts; Trauma Research Program, McLean Hospital, Belmont, Massachusetts Steven D. Passik, PhD, Symptom Management and Palliative Care Program, Markey Cancer Center, University of Kentucky, Lexington, Kentucky