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

The Pregnant Patient With Substance Use Disorder

Topics: Addiction Treatment | fetal effects | Pregnancy

CATR: Could you tell us what your role is and what you do? Dr. Forray: I’m an associate professor of psychiatry at Yale and I do research on treatments for pregnant and postpartum patients with substance use disorders (SUDs). Clinically, I’m the interim chief of the Section of Psychological Medicine at Yale New Haven Hospital and work with patients

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Research Update

Cannabidiol for Crack-Cocaine Craving: Negative Findings

Topics: Addiction Treatment | Cannabidiol | Cocaine | craving

Review of: de Meneses-Gaya C et al, Braz J Psychiatry 2020 (Epub ahead of print) Cocaine use disorder is notoriously difficult to treat, with no approved pharmacological treatments. Brazil, where this study was done, is said to have one of the highest cocaine consumption rates in the world (Abdalla RR et al, Addict Behav 2014;39(1):297–301), and us

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Expert Q&A

Integrating Medication Prescribing and Psychotherapy

Topics: Addiction Treatment | Cognitive Behavioral Therapy | Motivational Interviewing | Therapy during medication appointment

CATR: Set the stage for us on how you approach psychotherapy in addiction treatment. Dr. Marienfeld: I look at every interaction as a potential psychotherapeutic opportunity, whether it is “supposed” to be for psychotherapy or not. There is no strict separation when it comes to somebody with a substance use disorder. To begin with, I approach each

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Clinical Update

Smartphone Apps as Adjuncts for Substance Use Treatment

Topics: Addiction Treatment | Behavioral therapy | Complementary treatments | Computers in Psychiatric Practice | electronic use | Health Apps | Internet | Media | Telehealth | Telemedicine

The majority (81%) of Americans own a smartphone, and a little over one-half (58%) have downloaded a health-related app (www.pewresearch.org/internet/fact-sheet/mobile). Could addiction apps be the next tool to improve treatment outcomes? This article will review some apps for substance use disorders (SUD) and discuss strategies for integrating them int

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Expert Q&A

Alternative Therapies for SUDs

Topics: Addiction Treatment | Complementary treatments | Connection | Internet | Media | Medication

CATR: Please tell us about your work. Dr. Novella: As an academic neurologist at Yale, I spend most of my time seeing patients, usually in the context of teaching students, residents, fellows, etc, and I do some clinical research. I also run the site Science-Based Medicine (www.sciencebasedmedicine.org), which promotes high standards of science through

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Clinical Update 2

When to Stop Addiction Treatment: How Long Is Enough?

Topics: Addiction Treatment | Alcohol use disorder | Buprenorphine | Clinical practice | Medication adherence | retention

When a patient with a substance use disorder (SUD) has that “reachable moment” and/or recognizes the need to seek help, we know the importance of decreasing barriers to start treatment. However, what is less clear is when to stop treatment. What indicators suggest stable recovery? Recovery process The DSM-5 definition of remission from SUD is ba

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Expert Q&A 2

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

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In Brief

Under the Pandemic Influence

Topics: Addiction Treatment | COVID-19 | pandemic

Stay-at-home orders in many US states, which began in early 2020, have been associated with increased alcohol sales, particularly via online outlets. The World Health Organization issued a warning in April 2020 that alcohol use may potentially exacerbate poor health during the coronavirus disease 2019 (COVID-19) pandemic. How has the pandemic influenced

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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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