The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 1 CME credit.
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Extended-release naltrexone (Vivitrol) has had some good data, yet getting patients on it remains a challenge, because an opioid-free period is required before starting it. Understandably, practitioners get nervous when patients stabilized on buprenorphine ask to be transitioned to extended-release (XR) naltrexone.
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We have a good array of smoking cessation treatments to choose from, including nicotine replacement therapy (NRT), bupropion, and varenicline. Varenicline is the most effective monotherapy agent, somewhat better than bupropion and single-product NRT, and comparable to combination NRT.
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Electronic cigarette use, or vaping, is becoming increasingly common. Companies manufacturing e-cigarettes advertise them as alternatives to conventional cigarettes and even a pathway to smoking cessation. However, the popularity of vaping has sky-rocketed in high schools across the country with adolescents becoming addicted to nicotine daily.
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We don’t have definitive general population rates, but several statewide surveys suggest that perhaps 20% of adults have had at least one TBI with loss of consciousness in their lifetime. In studies done in addiction treatment settings, that number is more like 50%. And the prevalence is greater among clients in higher levels of care.
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We hear a lot about traumatic brain injury (TBI) nowadays: among NFL players (as in the movie ‘Concussion’), and as a signature diagnosis among recent combat veterans. What doesn’t get as much press coverage is the impact of TBI on those suffering from addiction.
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Dr. Capurso is the Assistant Director of Addiction Services at Connecticut Valley Hospital and an associate clinical professor of psychiatry at the Yale University School of Medicine. Prior to joining Connecticut Valley Hospital, he was the medical director of the Detoxification & Addiction Stabilization Service and the Psychosocial Residential Rehabilitation Program at the West Haven Veterans Administration Hospital. He completed medical school, psychiatry residency, and addiction psychiatry fellowship at Yale.
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