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Alcohol and nicotine addiction mostly occur together. Over the last ten years therapeutic aspects and motivational strategies have been considerably improved. Hence, groups and subgroups have been defined and can be treated with specific medication and tailor-made psychotherapies, leading in the long term to considerably better and more effective results than the once broadly applied, rigorous abstinence -based therapies. However, alcohol and nicotine addiction still represent major medical and social problems.

In this book, new therapeutic approaches are comprehensively described, outlining the different interactions between personality, environment and the effects of the substance.

In addition to prevention-based therapies and diagnosis, essential psychological and sociological strategies, as well as medication-based therapies, are also presented in detail. All of these therapies have realistic aims and are of global validity. In addition, the book provides a broad overview of the American and European epidemiology of alcohol and nicotine addictions. The book is written for all those who care for and offer professional therapy for alcohol and nicotine-addicted patients.

Alcohol and Tobacco: Medical and Sociological Aspects of Use, Abuse and Addiction

1 Information on the origination of the book

1.1 Aims of this book

1.2 Personal reasons for the first author writing this book

2 Addiction- a short overview over a widespread disease

2.1 Introduction

2.2 Prevention

2.3 Diagnosis of addiction

2.4 Aetiology of addiction

2.5 Secondary disorders and addiction

2.6 Secondary diseases and brain functions

2.7 Subgroups of addicts

2.8 Motivation of addicts

2.9 The path from motivation to therapy

2.10 Addiction and relapse

2.11 Specific groups of addicts

2.11.1 Co-morbidity of tobacco and alcohol addiction

2.11.2 Overweight, eating disorders

2.11.3 Gender

2.12 Addiction and the homeless

2.13 Polytoxicomania

2.14 Non-substance dependence

3 Aetiology of Addiction

3.1 The psycho-socio-biological model

3.2 Psychological theories

3.2.1 Behavioural approaches

3.2.2. Models of depth psychology

3.2.3 Depth psychological approach

3.2.4 Ego-psychological approaches

3.2.5 The psychological model of object relations

3.2.6 Approach according to theories of Narcissism

3.2.7 Explanation models according to family psychotherapy

3.3 Social explanation approaches

3.4 Biological theories about the aetiology of tobacco and alcohol addiction

3.4.1 Important findings about tobacco and alcohol use from basic research

3.4.2 Aspects of alcohol and tobacco metabolism

3.4.3 Maternal tobacco and alcohol use during pregnancy - a risk factor for the offspring?

3.4.3.1 Smoking during pregnancy

3.4.3.2 Alcohol use during pregnancy

3.5 Aetiological aspects of tobacco and alcohol addiction from an epidemiological perspective

3.6 Aetiology of addiction from a psychiatric perspective

4 Prevention strategies

4.1 Attitude towards addictive drugs

4.1.1 Attitudes towards alcohol consumption

4.1.2 Attitudes towards tobacco consumption

4.2 Primary prevention of tobacco and alcohol addiction

4.3 Secondary prevention: early diagnosis and early intervention

4.3.1 Conclusions for secondary prevention

4.3.1.1 Measures concerning the addictive drug

4.3.1.2 Measures for enabling adolescents to live drug-free

4.4 Tertiary prevention

5 Diagnosis of abuse and addiction

5.1 Problems concerning psychiatric diagnoses

5.2 Development of the term "addiction"

5.3 Substance related diagnoses in the ICD-10

5.3.1 Harmful use (ICD-10 F10.1, F17.1)

5.3.2 Dependence syndrome (ICD-10 F10.2, F17.2)

5.3.3 Withdrawal state (ICD-10: F10.3)

5.4 Substance related diagnosis in DSM-IV (American Psychiatric Association. 1994)

5.4.1 DSM-IV and the multidimensional diagnostic in five axes

5.4.2 Diagnosis according to DSM-IV axis I

5.4.2.1 Tobacco or alcohol abuse

5.4.2.2 Tobacco and alcohol addiction

5.4.3 Specifiers defining subgroups of dependence

5.4.3.1 Tolerance and withdrawl

5.4.3.2 Course specifiers

5.4.4 Therapeutic appraoch

5.4.5 Withdrawal symptoms of tobacco and alcohol

5.5 Commonalities and differences of ICD-10 and DSM-IV

5.6 Implication of these classification systems for therapy and research

5.6.1 Alcohol

5.6.1.1. Studies on medicamentous relapse prophylaxis (according to Hester RK and
Miller WR 2003)

5. 6.1.2 Studies on relapse prophylaxis using psychotherapy

5. 6.1.3 Family psychotherapy

5.6.2 Tobacco

6 Types, dimensions and aetiology

6.1 Alcohol addiction

6.1.1 Development of typology research

6.1.2 Important types for research and practice

6.1.2.1 Two-cluster solutions

6.1.2.2 The four-cluster solutions

6.1.3 Assessment of severity in different dimensions

6.1.3.1 Addiction Severity Index (ASI)

6.1.3.2 Syndrome diagnosis according to Scholz

6.2 Tobacco addiction
6.2.1 Smoking typology according to Schoberberger and Kunze

6.2.2 Smoking typology according to Fagerstroem

6.2.2 European Smoking Classification System

6.3 Alcohol addiction: Lesch's typology

6.3.1 Framework for the