Addiction Treatment

Welcoming Our New Editor-in-Chief

Topics: Addiction Treatment

We’re pleased to introduce Benjamin Oldfield, MD, MHS, as the new editor-in-chief of The Carlat Addiction Treatment Report. Dr. Oldfield is a clinical instructor at the Yale School of Medicine, and Chief Medical Officer at Fair Haven Community Health Care where he provides addiction treatment to adults and adolescents. He attended Harvard Medical

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Expert Q&A

Co-Occurring Addiction and PTSD

Topics: Addiction Treatment | Co-occurring disorders | PTSD | Substance Use Disorder | Trauma

CATR: We know PTSD often co-occurs with addiction. What should clinicians pay attention to? Dr. Vojvoda: Individuals who have PTSD have a high risk of developing other disorders, including substance use disorders (SUDs). Studies have shown that both in the veteran and non-veteran populations, these numbers are high. For example, one study of the genera

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Research Update

Oral vs Extended-Release Naltrexone for Opioid Use Disorder

Topics: Addiction Treatment | Naltrexone | Opioid Use Disorder | Research Update

Review of: Sullivan MA et al, Am J Psychiatry 2017;174(5):459–467 Extended-release (XR) naltrexone (Vivitrol) is FDA approved for opioid use disorder and has shown efficacy in several trials. It works best for patients who have already successfully detoxed from opioids and who are highly motivated to abstain. But what about oral naltrexone? While i

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Expert Q&A

Screening and Prophylaxis of Infectious Diseases in Addiction Practice

Topics: Addiction | Addiction Treatment | Hepatitis | HIV | Medical Comorbidities | Prevention | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Springer: I’m an infectious disease doctor who is addiction medicine board certified as well. My background clinically is treating HIV and infectious diseases, as well as opioid use disorder (OUD) and alcohol use disorder (AUD). My research is about how to best integrate infectious disease and OUD trea

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Clinical Update

PrEP: Introduction to the Basics

Topics: Addiction | Addiction Treatment | HIV | Medical Comorbidities | Medication | Pharmacology | Prevention | Substance Use | Substance use disorders

Great strides have been made in HIV treatment and prevention during the last 2 decades, resulting in falling numbers of new HIV infections during that time span. But since 2013, the rate of new infections has mostly plateaued at just under 40,000 new infections per year (www.hiv.gov). Those at highest risk of infection remain men who have sex with men,

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Expert Q&A

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

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Research Update

Exposure Therapy Efficacious for PTSD Co-Occurring With Alcohol Use Disorder

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Co-occurring disorders | Dual diagnosis | Prolonged exposure | Psychotherapy | PTSD | Research | Research Update | Substance Use | Substance use disorders

Review of: Norman SB et al, Efficacy 2019;76(8):791–799 Patients with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) have worse outcomes compared to patients with either diagnosis alone. Integrated approaches, in which both diagnoses are simultaneously addressed, are viewed as best practice. Providers, however, are

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Research Update

Varenicline and Bupropion: Soaring Again With EAGLES?

Topics: Addiction | Addiction Treatment | Bupropion | Chantix | Co-occurring disorders | Dual diagnosis | FDA Warnings | Medication | Pharmacology | Research | Research Update | Side Effects | Smoking Cessation | Smoking Cessation Agents | Substance Use | Substance use disorders | Suicidality | Suicide | Tobacco | Varenicline | Wellbutrin

Review of: Anthenelli RM et al, Lancet 2016;387(10037):2507–2520 Varenicline (Chantix) and bupropion (Zyban and others) are effective treatments for tobacco use disorder, but their use (and sales) took a big hit in 2009 when the FDA slapped both with black box warnings linking them to psychiatric complications, including suicidal ideation. Although

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Research Update

The COMBINE Study: A Core Paper in the Treatment of AUD

Topics: Acamprosate | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Pharmacology | Psychotherapy | Research | Research Update | Substance Use | Substance use disorders | Therapy during medication appointment | Therapy with Med Management

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

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Expert Q&A

Personal Privacy Versus Public Safety: Addiction Among Health Professionals

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

CATR: Tell us how your interest in addiction came about. Dr. Earley: When I started working in the world of addiction treatment 35 years ago, there wasn’t much specific training. I was trained as a neurologist and always had an interest in patients with substance use disorders. Ultimately, I decided to shift my specialty and wound up cobbling togethe

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Clinical Update

Learning From the Successes of Physician Health Programs

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

The rate of substance use disorders among physicians is around the same if not slightly higher than in the general population. Impaired physicians, however, are a public health threat, and in most states there is mandated reporting of impaired ­physicians (­Mossman D, Current Psychiatry 2011; 10(9):67–71). So what is to be done for an addicted or im

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Expert Q&A

Telemedicine for Addiction Treatment: Evidence and Implementation Strategies

Topics: Addiction | Addiction Treatment | pandemic | Special populations | Telehealth | Telemed | Telemedicine | Telepsychiatry

CATR: What gaps can technology fill when we work with patients with substance use disorders? Dr. Swendeman: Really, it’s about accessibility. In some ways, an in-person model where you require people to come to in-person visits could be considered a form of rationing of care. COVID-19 is creating silver-lining opportunities for telehealth to improve

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Clinical Update

Updated Guidelines for Treating Opioid Use Disorder

Topics: Addiction Treatment | Buprenorphine | Medication | Methadone | Opioid epidemic | Opioid Use Disorder | Pain | Pharmacology

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

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Issue Highlights

Highlights From This Issue

Topics: Addiction Treatment

Overdose education with naloxone distribution, syringe exchange, fentanyl testing, and pre-exposure prophylaxis for HIV prevention are strategies that addiction providers can use in practice to reduce harm from substance use. The CDC recommends naloxone prescriptions be offered to patients at risk for overdose, including those with opioid use disorde

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Research Update

New Hope: CBT for Internet and Computer Game Addiction

Topics: Addiction Treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Technology

Review of: Wölfling K et al, JAMA Psychiatry 2019;76(10):1018–1025 While many of us likely spend far too much time on our various devices—whether for fun or for work—between 0.3% and 1% of the general population might qualify for an internet gaming disorder (Przybylski AK et al, Am J Psychiatry 2017;174(3):230–236). Defined as excessive preo

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Clinical Update

Primer: Evidence-Based Psychosocial Interventions for Substance Use Disorders

Topics: Addiction | Addiction Treatment | Cognitive Behavioral Therapy | Motivational Interviewing | Psychotherapy | Substance Use Disorder

Evidence-based psychosocial interventions form a critical component of substance use disorder (SUD) treatment. However, clinicians may be less familiar with some of the newer modalities. This primer will help you make informed referrals and discuss options with your patients. Basic interventions Drug counseling Addiction counselors are the backbone o

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Expert Q&A

Treating Alcohol Use Disorder

Topics: Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Substance Use Disorder | Therapy with Med Management

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

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Clinical Update

Biomarkers of Alcohol Use

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Laboratory Testing in Psychiatry | Substance Use Disorder

We all want to know how much alcohol our patients are drinking. Asking patients directly about their drinking often generates useful information and helps build rapport, but this tactic is not always reliable. Denial and shame as well as issues related to secondary gain can sometimes contaminate self-report. Thankfully, there are many measures that can

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Research Update

N-acetylcysteine Not Effective for Cannabis Use Disorder in Adults

Topics: Addiction | Addiction Treatment | Cannabis | Marijuana | Substance Use Disorder

Review of: Gray KM et al, Drug and Alcohol Dependence 2017;177:249–257 N-acetylcysteine (NAC) is an over-the-counter supplement related to the amino acid cysteine. In addition to its use as an antidote for acetaminophen poisoning, it has shown evidence of efficacy in some psychiatric disorders. For substance use disorders, its primary mechanism of

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Article

Primer: Confidentiality in Addiction Treatment

Topics: Addiction | Addiction Treatment | Clinical practice | Confidentiality | HIPAA

Addiction remains stigmatized. In order to safeguard and encourage patient access to care, there are special privacy protections for individuals with substance use disorders (SUDs). This update will cover what you need to know using clinical vignettes. Clinical Scenario 1a: A 36-year-old man with heroin use disorder presents to your office for pharma

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