substance use disorder - Page 1

Medication or Therapy? A Clinical Framework for Substance Use Disorders

September 7, 2026

Today, we’re tackling a deceptively simple question that comes up all the time in clinical practice: When should we prioritize medication, when should we emphasize psychotherapy, and when can we recommend both? This question comes up especially often with patients who are new to treatment. They’ll ask, “Do I need a medication?” or “Can I just do therapy?” And while it’s tempting to answer in generalities, the evidence actually gives us much clearer guidelines, depending on the substance that the patient is using.

Clinical Update

Bipolar Disorder and Addiction: Untangling a Complex Overlap

November 1, 2025

Chris Aiken, MD

Chris Aiken, MD. Editor-in-Chief, The Carlat Psychiatry Report. Assistant Professor, NYU Langone Department of Psychiatry. Practicing psychiatrist, Winston-Salem, NC.

Dr. Aiken has no financial relationships with companies related to this material.

When bipolar disorder and substance use disorders co-occur patients can be difficult to diagnose and treat, particularly because they often present with mixed states rather than classic mood episodes. This article reviews evidence-based treatment approaches for specific substance combinations, including valproate for alcohol use, citicoline for stimulant use, and considerations for managing this complex dual diagnosis.

Research Update

Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder

November 1, 2025

Anna Vinter, MD

Anna Vinter, MD. Dr. Vinter has no financial relationships with companies related to this material.

Alcohol use disorder (AUD) is notoriously difficult to treat, with pharmacological options often underutilized or only modestly effective. But what if a medication already used for diabetes and obesity could help?

Teen Substance Use: Choosing the Right Care

June 2, 2025

Joshua Feder, MD and Mara Goverman

A teen is using substances—how do you decide what kind of treatment makes sense? Outpatient therapy? A more structured program? We’re breaking it down.

Identifying and Treating Substance Use in Correctional Settings

April 1, 2025

Joshua Sonkiss, MD

Joshua Sonkiss, MD. President of Sonkiss Medical Consulting, LLC, Tucson, AZ.

Dr. Sonkiss has no financial relationships with companies related to this material.

Substance use in correctional settings is a hidden crisis that significantly impacts the health and safety of both patients and staff.

Note From the Editor-in-Chief

January 1, 2025

Joshua D. Feder, MD

In our note from the Editor in Chief, Dr. Feder underlines the hope for better outcomes for the ravages of substance use disorders and a timely message for those impacted wildfires and other disasters.

Clinical Update

Effective Management of Buprenorphine-Precipitated Opioid Withdrawal

January 1, 2025

Jaewon Lee, MD, MPH

Jaewon Lee, MD, MPH. PGY-2, psychiatry resident, University of Rochester Medical Center, Rochester, NY.

Dr. Lee has no financial relationships with companies related to this material.

Buprenorphine is a first-line treatment for opioid use disorder, however, given buprenorphine to a patient who still has opioids in their system can precipitate severe withdrawal. Careful assessment of withdrawal can minimize the risk, but despite our best efforts, precipitated withdrawal can still occur. In this article, we review what to do for our patients experiencing buprenorphine-precipitated opioid withdrawal.

Clinical Update

Drug Testing and the Legal System

July 1, 2024

Paul A. Bryant, MD

Paul A. Bryant, MD, Assistant Professor of Psychiatry; Stephanie Eng, MD, Fellow in Forensic Psychiatry; Melissa Lavoie, MD, Fellow in Forensic Psychiatry. Yale University, New Haven, CT.

Drs. Bryant, Eng, and Lavoie have no financial relationships with companies related to this material.

Urine drug screens are frequently ordered for patients receiving addiction treatment. However, the results of these everyday tests can have outsized consequences for patients involved in the legal system. Here, we provide an overview of how drug testing is used in the legal system and how you can be an advocate for your patient.

How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

Satisfy the DEA requirement for 8 hours of training in opioid or other substance use disorders

May 24, 2024

Clinical Update

A Spotlight on Two Emerging Nootropics

February 10, 2024

Jeremy Weleff, DO., Akhil Anand, MD., and Julian J. Raffoul, MD, PhD.

Jeremy Weleff, DO. Yale School of Medicine, New Haven, CT; Cleveland Clinic, Cleveland, OH. Akhil Anand, MD. Cleveland Clinic, Cleveland, OH. Julian J. Raffoul, MD, PhD. Vanderbilt University Medical Center, Nashville, TN.

Dr. Weleff, Dr. Anand, and Dr. Raffoul have no financial relationships with companies related to this material.

Nootropics are a broad class of medications encompassing many different mechanisms of action that are marketed as cognitive enhancers. Not only do most nootropics lack evidence of efficacy, but some can have dangerous side effects and addictive potential. Here, we discuss some of the most concerning nootropics being widely used today.