Addiction Press

Substance use and addiction is an increasing problem amongst older people. The identification of this problem is often more difficult in older patients and is frequently missed, particularly in the primary care context and in emergency departments, but also in a range of medical and psychiatric specialties. Substance Use and Older People shows how to recognise and treat substance problems in older patients. However, it goes well beyond assessment and diagnosis by incorporating up-to-date evidence on the management of those older people who are presenting with chronic complex disorders, which result from the problematic use of alcohol, inappropriate prescribed or over the counter medications, tobacco, or other drugs. It also examines a variety of biological and psychosocial approaches to the understanding of these issues in the older population and offers recommendations for policy. “Substance Use and Older People” is a valuable resource for geriatricians, old age psychiatrists, addiction psychiatrists, primary care physicians, and gerontologists as well as policy makers, researchers, and educators. It is also relevant for residents and fellows training in geriatrics or geri-psychiatry, general practitioners and nursing home physicians.

The book presents an integrative theory of hard-to-maintain behaviours, that includes hard-to-reduce or eliminate behaviours like smoking and other drug use, overconsumption of food or unsafe sex, and hard-to-sustain behaviours like exercise and sun-safe behaviours. Most of the examples come from the author's work on tobacco smoking, but it is relevant to anyone who is concerned to understand why some forms of desirable behaviour are so hard to achieve, and to those trying to help people change. It also has important implications for public health campaigns and for the development of policies to nudge behaviour in desirable ways. The book provides readers with frameworks to: • Determine whether a "hard to maintain" behaviour is a result of the skills needed to perform it, its reinforcement history, the way the person thinks about it, the context, or some combination of these. • Better integrate cognitive and behavioural change strategies, including emergent strategies related to mindfulness and acceptance, plus novel ways of retraining operational processes. • Understand the different nature of challenges for behaviours where multiple attempts are typically required before the desired behaviour pattern is sustained. • Better understand the role of feelings and emotions as influences on behaviour. • Understand the limits of environmental factors to determine change. • Understand the limits of self-control and will-power.

Harm Reduction is a philosophy of public health intended as a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices. Recognising that certain people always have and always will engage in behaviours which carry risks, the aim of harm reduction is to mitigate the potential dangers and health risks associated with those behaviours. Harm Reduction in Substance Use and High-Risk Behaviour offers a comprehensive exploration of the policy, practice and evidence base of harm reduction. Starting with a history of harm reduction, the book addresses key ethical and legal issues central to the debates and developments in the field. It discusses the full range of psychoactive substances, behaviours and communities with chapters on injecting, dance drugs, stimulant use, tobacco harm reduction, alcohol use and sex work. Written by an international team of contributors, this text provides an essential panorama of harm reduction in the 21st century for educators and researchers in addiction and public health, postgraduate students and policy makers.

The word 'addiction' these days is used to refer to a chronic condition where there is an unhealthily powerful motivation to engage in a particular behaviour. This can be driven by many different factors—physiological, psychological, environmental and social. If we say that it is all about X, we miss V, W, Y and Z. So, some people think addicts are using drugs to escape from unhappy lives, feelings of anxiety and so on; many are. Some people think drugs become addictive because they alter the brain chemistry to create powerful urges; that is often true. Others think that drug taking is about seeking after pleasure; often it is. Some take the view that addiction is a choice—addicts weigh up the pros and cons of doing what they do and decide the former outweigh the latter. Yet others believe that addicts suffer from poor impulse control; that is often true... And so it goes on. When you look at the evidence, you see that all these positions capture important aspects of the problem—but they are not complete explanations. Neuroscience can help us delve more deeply into some of these explanations, while the behavioural and social sciences are better at exploring others. We need a model that puts all this together in a way that can help us decide what to do in different cases. Should we prescribe a drug, give the person some 'tender loving care', put them in prison or what? Theory of Addiction provides this synthesis.