OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Addiction Medicine Published and forthcoming Oxford Handbooks Oxford Clinical Guidelines: Newly Qualified Doctor Oxford Handbook for the Foundation Programme 5e Oxford Handbook of Acute Medicine 4e Oxford Handbook of Anaesthesia 5e Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Healthcare Research Oxford Handbook of Clinical and Laboratory Investigation 4e Oxford Handbook of Clinical Dentistry 7e Oxford Handbook of Clinical Diagnosis 3e Oxford Handbook of Clinical Examination and Practical Skills 2e Oxford Handbook of Clinical Haematology 4e Oxford Handbook of Clinical Immunology and Allergy 4e Oxford Handbook of Clinical Medicine 11e Oxford Handbook of Clinical Pharmacy 3e Oxford Handbook of Clinical Specialties 11e Oxford Handbook of Clinical Surgery 5e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3e Oxford Handbook for the Dental Foundation and Core Training Programmes Oxford Handbook of Dialysis 4e Oxford Handbook of Emergency Medicine 5e Oxford Handbook of Endocrinology and Diabetes 4e Oxford Handbook of ENT and Head and Neck Surgery 3e Oxford Handbook of Epidemiology for Clinicians Oxford Handbook of Expedition and Wilderness Medicine 3e Oxford Handbook of Forensic Medicine Oxford Handbook of Gastroenterology & Hepatology 3e Oxford Handbook of General Practice 5e Oxford Handbook of Genetics Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health 3e Oxford Handbook of Geriatric Medicine 3e Oxford Handbook of Infectious Diseases and Microbiology 2e Oxford Handbook of Integrated Dental Biosciences 2e Oxford Handbook of Head and Neck Anatomy Oxford Handbook of Humanitarian Medicine Oxford Handbook of Key Clinical Evidence 2e Oxford Handbook of Medical Dermatology 2e Oxford Handbook of Medical Ethics and Law Oxford Handbook of Medical Imaging Oxford Handbook of Medical Sciences 3e Oxford Handbook for Medical School Oxford Handbook of Medical Statistics 2e Oxford Handbook of Neonatology 2e Oxford Handbook of Nephrology and Hypertension 2e Oxford Handbook of Neurology 2e Oxford Handbook of Nutrition and Dietetics 3e Oxford Handbook of Obstetrics and Gynaecology 4e Oxford Handbook of Occupational Health 3e Oxford Handbook of Oncology 3e Oxford Handbook of Operative Surgery 3e Oxford Handbook of Ophthalmology 4e Oxford Handbook of Oral and Maxillofacial Surgery 2e Oxford Handbook of Orthopaedics and Trauma Oxford Handbook of Paediatrics 3e Oxford Handbook of Pain Management Oxford Handbook of Palliative Care 3e Oxford Handbook of Pathology 3e Oxford Handbook of Practical Drug Therapy 2e Oxford Handbook of Pre-Hospital Care 2e Oxford Handbook of Psychiatry 4e Oxford Handbook of Public Health Practice 4e Oxford Handbook of Rehabilitation Medicine 3e Oxford Handbook of Reproductive Medicine & Family Planning 2e Oxford Handbook of Respiratory Medicine 4e Oxford Handbook of Rheumatology 4e Oxford Handbook of Sleep Medicine Oxford Handbook of Sport and Exercise Medicine 2e Handbook of Surgical Consent Oxford Handbook of Tropical Medicine 5e Oxford Handbook of Urology 4e OXFORD HANDBOOK OF Addiction Medicine THIRD EDITION EDITED BY John B. Saunders Professor and Consultant Physician in Internal Medicine and Addiction Medicine, National Centre for Youth Substance Use Research, The University of Queensland, Specialty of Psychiatry, University of Sydney, and Wesley Hospital and Waratah Private Hospital, Sydney, NSW, Australia David J. Nutt Professor of Neuropsychopharmacology, and Director of the Neuropsychopharmacology Unit, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK Susumu Higuchi Emeritus Director, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan Sawitri Assanangkornchai Professor of Psychiatry, Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand Henrietta Bowden-Jones Founder and Director of the National Centre for Behavioural Addictions, London, UK, Honorary Professor, Faculty of Brain Sciences, University College, London, and Visiting Senior Research Fellow, Department of Psychiatry, Cambridge University, London, UK Wim van den Brink Emeritus Professor of Psychiatry and Addiction, Amsterdam University Medical Centers, Academic Medical Center, Department of Psychiatry; Amsterdam, The Netherlands Professor Honoris Causa, Eötvös Loránd University, Budapest, Hungary Yvonne Bonomo Consultant Physician in Addiction Medicine and Adolescent Medicine; Director, Department of Addiction Medicine, St Vincent's Hospital, Melbourne; Medical Head of Women's Alcohol and Drug Service, Royal Women's Hospital; Professor, Department of Medicine, University of Melbourne, Victoria, Australia Vladimir Poznyak Head of the Alcohol, Drugs and Addictive Behaviours Unit at the World Health Organization (WHO) Headquarters, Geneva, Switzerland Andrew J. Saxon Professor, University of Washington School of Medicine; Director, Center of Excellence in Substance Addiction Treatment and Education; VA Puget Sound Health Care System, Seattle, WA, US Sir John Strang Professor of Psychiatry and Head of Department, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2024 The moral rights of the authors have been asserted First Edition published in 2009 First Edition, revised and updated in 2011 Second Edition published in 2016 Third Edition published in 2024 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2023943534 ISBN 978–0–19–284408–8 eISBN 978–0–19–265790–9 DOI: 10.0001 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct.
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Foreword Addictions are highly prevalent. They cause harm to the afflicted and their families and are costly to society. While the clinical symptomatology in people suffering from addictions is similar around the world, treatment and prevention are not. Research in recent years has provided enormous progress in our understanding of these disorders resulting in a multitude of new evidence-based treatments.
However, most conditions remain underserved and treatment approaches vary substantially around the world. All of these facts call for an up-to-date and universal appraisal of the current situation. A comprehensive overview on emerging strategies would be instrumental in this and could help to meet the actual challenges. Addiction Medicine provides a global perspective.
The editors and authors are eminent researchers and clinicians in our field. They come from a large variety of areas such as Australia, Asia, Europe, and North America. While the first and second editions of this textbook provided a very broad view on addictions and ways of dealing with them, the revised version gives an update of current concepts and newly emanating strategies. Important extensions have been made providing several new chapters and incorporating new fields such as gambling and gaming as examples for behavioural addictions.
The handbook now also includes evidence-based recommendations from the most recent clinical guidelines from around the world. Professor John Saunders of Queensland and Sydney Universities and his colleagues are to be congratulated for their enormous efforts. Their handbook Addiction Medicine gives the necessary detail to understand and respond to actual problems in an individual patient. The long-standing teaching experience of most of its authors has resulted in a text which is well structured and easy to read and thus offers information not only to the professional but also to the patient and their family and to others in search of some quick and valid information on the challenging but also fascinating field of addiction.
Karl Mann, MD Emeritus Professor of Addiction Research Central Institute of Mental Health Medical Faculty Mannheim University of Heidelberg Germany Preface Origin of this handbook Addiction Medicine, now in its third edition, is the result of many years’ preparation by a group of colleagues who are clinicians, teachers, and researchers in the addictive disorders field. The present edition replaces the two previous editions and two intermediary updates. This text has its origins in a series of lecture notes produced for student teaching and postgraduate training programmes over the past 40 years, but it has been continually updated over the years. The aim of Addiction Medicine is to be a contemporary, broadly based, and clinically grounded text that summarizes the scientific basis and practice of addiction medicine.
It provides practical guidance on clinical management but with a sound background of pharmacology, neurobiology, psychology, and epidemiology and public health. It seeks to provide approaches to minimizing harm from psychoactive substances and addictive behaviours, both at an individual and a societal level. The scope of the third edition has been expanded in several ways. In addition to the behavioural addictions, it covers a broader range of psychoactive substances.
There are new chapters on screening and brief intervention and on digital health approaches. It aims to be international in scope. The editors are drawn from the UK, Australia, the US, Japan, Belarus, Thailand, and the Netherlands. The contributing authors are based in over 30 countries worldwide.
Evidence and practice Evidence-based practice continues to increase in impact. There is an expectation that the management of addictive disorders, including the selection of medications, therapies, and the overall strategy, will be based on scientific data from controlled clinical trials and other relevant studies. This applies in addiction medicine as much as it does in any other field of healthcare. We recognize that, as in other areas of healthcare, the scientific evidence base is not comprehensive, particularly when a person with an addictive disorder has different comorbidities, or when standard treatment approaches have been exhausted, or simply where the evidence base is lacking.
We acknowledge the particular insights and contributions of our colleagues who have the lived experience of addictive disorders. We note the interpersonal skills necessary to engage people who often feel stigmatized and marginalized in society. Our approach to the third edition has been to draw upon the following sources: Current guidelines (developed according to contemporary international standards) published by the World Health Organization, national governments, and regional authorities, and by professional organizations and academies in numerous countries. We have given precedence to those based on systematic reviews of the clinical scientific literature and which have undergone extensive processes of validation.
Publicly accessible scientific evidence on the efficacy of treatment (with an emphasis on systematic reviews, meta-analyses, and randomized controlled trials), supplemented by other scientifically valid clinical, psychometric, and epidemiological studies. The clinical practice and experience of the authors, ensuring that the recommendations are appropriate to many clinical practice settings and, where there is an absence of evidence from scientific studies, that the material published here represents a distillation of practice which we consider to have international relevance and to be effective and safe. It should be emphasized that in clinical practice, decisions need to be made frequently in the absence of scientific evidence. Often the clinical situation develops beyond what scientific evidence exists or could ever realistically be expected to exist.
In clinical practice, the focus is on the individual (or couple, family, or group) and individuals and groups of individuals are infinitely variable.