Cover -- Half-title -- Title -- Copyright -- Dedication -- Contents -- Foreword: Welcoming the fifth edition -- A note on the fifth edition -- Introduction -- Section 1: Background to understanding -- Section 2: Treatment: context and content -- Section 1 Background to understanding -- Chapter 1 Definitions of drinking problems -- What is a 'drinking problem'? -- The many faces of drinking problems -- A population perspective on drinking -- Sensible drinking or 'normal drinking' -- Quantity/frequency definitions -- Categories of alcohol misuse: alcohol use disorders -- Hazardous drinking -- Harmful drinking -- Alcohol dependence (syndrome) -- Clinical genesis of the concept -- Alcohol dependence: establishing syndrome validity -- Elements of the alcohol dependence syndrome -- Narrowing of repertoire -- Salience of drinking -- Increased tolerance to alcohol -- Withdrawal symptoms -- Nausea -- Sweating -- Mood disturbance -- Relief or avoidance of withdrawal symptoms by further drinking -- Subjective awareness of compulsion to drink -- Reinstatement after abstinence -- Should dependence be diagnosed in the absence of withdrawal symptoms? -- The time element -- Why an understanding of dependence matters -- The dependence concept and the brokerage of understanding -- The relevance of an understanding of dependence to the specifics of treatment -- The range of drinking problems -- References -- Chapter 2 Alcohol as a drug -- The purpose of this chapter -- What's in an alcoholic drink? -- Pharmacology -- The complexity of scientific notation -- Standard drinks worldwide -- The Great British unit -- Absorption and distribution -- Excretion and metabolism -- Hepatic alcohol metabolism -- Extrahepatic alcohol metabolism -- Acute pharmacological effects -- Cardiovascular system -- Body temperature -- Gastrointestinal tract -- Kidney -- Respiration.

Central nervous system -- Sites of action -- Alcohol and the GABA-receptor complex -- Alcohol and the glutamate receptor -- GABA and glutamate in tolerance and dependence -- Alcohol and the dopamine receptor -- Alcohol and the endogenous opioid system -- Reinstatement -- Future directions -- References -- Chapter 3 Causes of drinking problems -- Availability of the drug -- Norms and values -- Economic factors -- Genetics -- Disorder and chronic stress -- Application to practical contexts -- References -- Chapter 4 Social complications of drinking problems -- Pinpointing the 'complications' of drinking problems in individual lives is rarely simple -- One person's complication is another person's benison -- The social contexts of problem drinking are to some extent selected, and to some extent select -- A person's resources moderate the strength of the link between drinking problems and social complications -- Family complications of problem drinking -- The partner -- A history from the partner as an individual -- How drinking problems affect the partner and the relationship -- Relationships in which both partners have a drinking problem -- Coping styles of partners -- Children -- Experiences to which children are exposed -- Problems that children develop -- Work and education -- Violence and other crime -- Multiple relationships -- The individual's drinking and their risk of being a victim of crime -- Drink-driving offenders -- Financial and housing stability -- References -- Chapter 5 Physical complications of excessive drinking -- Why physical complications matter -- Physical complications -- Acute alcohol intoxication and coma -- Cancers -- Cardiovascular disease -- Alcohol-related arrhythmias -- Hypertension -- Cerebrovascular disease -- Coronary heart disease -- Cardiomyopathy -- Gastroenterological disorders -- Alcoholic liver disease.

Fatty liver -- Alcoholic hepatitis -- Alcoholic cirrhosis -- Acute pancreatitis -- Chronic pancreatitis -- Gastritis, peptic ulceration and intestinal symptoms -- Mallory-Weiss syndrome -- Endocrine and metabolic disorders -- Type II diabetes -- Alcohol-induced pseudo-Cushing's syndrome -- Male hypogonadism -- Hypoglycaemia -- Alcoholic ketoacidosis -- Gout -- Hyperlipidaemia -- The immune system -- Alcoholic muscle, skin and bone disease -- Effects of alcohol on skeletal muscle -- Effects of alcohol on skin -- Effects of alcohol on bone -- Respiratory disease -- Respiratory tract infection -- Adult respiratory distress syndrome -- Haematological effects -- Anaemia -- Macrocytosis -- Iron deficiency -- Neutropaenia and thrombocytopaenia -- Accidents/trauma -- Surgery -- Neurological disorders -- Alcohol withdrawal seizures -- Seizures of other origin -- Peripheral neuropathy -- Alcoholic cerebellar degeneration -- Wernicke-Korsakoff syndrome -- Wernicke's encephalopathy -- Korsakoff's syndrome -- Alcohol-related brain damage -- Central pontine myelinolysis -- Marchiafava-Bignami disease -- Alcohol amblyopia -- Hepatic encephalopathy -- Fetal alcohol spectrum disorders -- The need for two kinds of alertness -- References -- Chapter 6 Drinking problems and psychiatric disorders -- Epidemiology -- Alcohol-induced disorders -- Transient hallucinatory experience -- Delirium tremens -- The clinical picture -- Delirium -- Hallucinations and illusions -- Tremor -- Fear -- Paranoid delusions -- Occupational delusions or hallucinations -- Restlessness and agitation -- Heightened suggestibility -- Physical disturbances -- Aetiology and course -- Possibilities of diagnostic confusion -- Alcoholic hallucinosis -- Alcohol-induced psychotic disorder with delusions -- 'Pathological intoxication' -- Alcoholic blackouts (alcohol-induced amnestic episodes).

Blackouts and their significance to the patient -- Co-morbid disorders -- Depression -- Depressive illness -- Drinking problems and depression: their relationship -- Depression and drinking problems: the practical importance of the diagnostic question -- Suicide -- Bipolar disorder -- Anxiety -- Post-traumatic stress disorder -- Personality disorder -- Pathological jealousy -- Attention deficit hyperactivity disorder -- Psychosis and schizophrenia -- Eating disorders -- Damage to the tissue of the brain -- Psychiatric disorder: the general implications -- References -- Chapter 7 Alcohol and other drug problems -- Polydrug use -- Adolescents -- Specific combinations -- Alcohol and nicotine -- Alcohol and cocaine -- Alcohol and cannabis -- Alcohol and opioids -- Alcohol and benzodiazepines -- 'A web of dependence' -- Alcohol and other drugs as one domain: the practical implications -- Implications for training and service organization -- A prime responsibility for prevention -- Diagnosis and screening -- Treatment goals -- A constant two-way vigilance -- References -- Chapter 8 Various presentations -- The young drinker -- Possibilities for growth -- Special difficulties -- Taking the problems of the young drinker very seriously -- The patient who is drunk and violent -- Mr Smith: agreed treatment plan -- A presentation on a general hospital ward -- The pregnant drinker -- A combined problem with drink and drugs -- The patient with cognitive impairment -- Alcohol problems in later life -- Help for the older patient -- The patient from a cultural background other than the therapist's -- The family member as intermediary -- The 'very important patient' -- A child at risk -- The child's safety and welfare must come first -- Do not panic, but err on the side of caution -- Try to work with, rather than against, the parents.

Assess the total background family situation and interactions rather than focus only on the drinking -- Assess the parental drinking history and the likely consequences of the drinking for the child -- Examination of the child -- Setting up an appropriate level of safeguard and monitoring -- All presentations are special presentations -- References -- Section 2 Treatment: context and content -- Chapter 9 Introduction, settings and roles -- Trajectories of help-seeking and progress or regress in the drinking problem -- The 'messy' treatment of drinking problems -- References -- Chapter 10 Non-specialist settings -- Most drinking problems are not encountered in specialist care -- Many interventions outside of specialist care fail in their intended purpose due to the unappreciated influence of drinking problems -- Non-specialist settings provide the chance to influence low-level problems before they become serious -- Non-specialist settings in which drinking problems are prevalent -- Criminal justice -- The workplace -- Schools/colleges/universities -- Primary care -- Accident and Emergency Departments -- Obstetrics/gynaecology clinics -- Elderly care settings -- The special case of general psychiatry/mental health services -- Key differences between non-specialist and specialist settings -- Case-finding and detection -- The use of disarming questions -- Remembering who may be especially at risk -- Common social presentations -- Common psychiatric clues -- Common medical clues -- Not overlooking the obvious -- Having a word with the spouse or partner -- Laboratory tests -- Sensitivity and specificity -- Screening tests for heavy drinking -- Mean corpuscular volume -- Liver function tests -- Carbohydrate-deficient (desialylated) transferrin -- Blood alcohol concentration -- Other potential biomarkers of alcohol consumption.

Laboratory tests: an overall judgement.