The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Dec 2004
ReviewOccupational exposure and addictions for physicians: case studies and theoretical implications.
Risk of addiction through occupational exposure to drugs of abuse is an important but relatively neglected public health problem. Stress and access may have much less of a role in addiction among certain populations than originally was thought. ⋯ Additional studies of the relationship between exposure in the workplace and addiction are necessary. These studies should include biological measures, such as blood levels in exposed workers, and sensitive assays that quantitatively assess levels of exposure in the workplace.
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Dual diagnosis patients come to treatment with a variety of deficits,talents, and motivations. A biopsychosocial treatment plan involves multiple interventions, including medications, medical treatment, psychotherapy, family therapy, housing, and vocational rehabilitation. Treatment must be individualized and integrated, and this requires collaboration among a variety of health caregivers. ⋯ The bidirectional model is consistent with the tendency of disturbed teenagers to socialize with youth using alcohol and drugs; however, this model has not been tested rigorously in research studies. With such a disparate set of models, behavior interventions are conceptualized best as a multi-component program, a treatment plan that generates a problem list and devises an intervention to respond to each member of the list. This requires a talented, multi-disciplinary team or network that can assess carefully and package the interventions creatively, and dose the treatment components empathically to fit the patient's tolerance, motivation, and abilities.