Addiction

Article

Low-Risk Drinking Limits: What Should We Tell Older Adult Patients?

Topics: Addiction | Substance Abuse

How much can our older patients safely drink? And what does “safe” or “low-risk” drinking actually mean? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the branch of the NIH that focuses on problems related to alcohol, has released guidelines for low-risk drinking limits in older patients. Let’s take a look at their r

Read More
Research Update

Opioids Not Superior to Other Medicines for Some Chronic Pain

Topics: Addiction | Free Articles | Research Update | Substance Abuse

REVIEW OF: Krebs EE et al, JAMA 2018;319(9):872–882 Rising rates of opioid overdose deaths have sounded alarm bells over opioid prescribing practices for chronic pain. Unfortunately, and despite the absence of quality data on their risks vs benefits, long-term opioid management has remained a common approach to managing chronic musculoskeletal pain

Read More
Article

Sleep Apnea in Patients With Substance Use Disorders: A Primer

Topics: Addiction | Sleep Disorders | Substance Abuse

A 55-year-old male patient you have been treating for alcohol use disorder has been struggling with withdrawal following detox. He tells you his spouse is complaining about his severe and disruptive snoring, and he says he feels “wiped out” all day, even falling asleep at work. He then admits that, to stay alert, he has been regularly taking Adderal

Read More
Expert Q&A

Treating Insomnia With Addiction

Topics: Addiction | Sleep Disorders | Substance Abuse

CATR: With substance use disorders (SUDs) that are comorbid with chronic insomnia, what would you say are some of the main treatment challenges? Dr. Hermes: The first thing I’d say is that chronic insomnia has a high comorbidity rate with SUDs as well as general psychiatric conditions and medical conditions, including chronic pain, COPD, heart diseas

Read More
Article

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

Read More
Article

Adolescents With ADHD and Substance Use Disorders: A Primer

Topics: Addiction | ADHD | Child Psychiatry | Registered Articles | Substance Abuse

You are evaluating a 16-year-old boy referred for mandated substance use treatment by his high school, where he was found drinking alcohol and smoking cannabis with a friend in the restroom. As you gather his history, he says, “One doctor told me I have ADHD. That’s why I smoke pot—it helps me focus. But I think I’d do better with some Adderall.

Read More
Expert Q&A

Talking to Parents and Adolescent Patients About Substance Use

Topics: Addiction | Child Psychiatry | Practice Tools and Tips | Substance Abuse

CATR: To start us off, how does addiction differ in adolescents vs adults? Dr. Quigley: In adolescents it can be subtle. For example, there are culturally normative behaviors with alcohol and cannabis use, and kids get missed because people write it off as “just partying.” They miss the fact that the substance use has become extremely impairing. Ad

Read More
Expert Q&A

The Neuroscience Behind Addictions and SSRIs

Topics: Addiction | Neuroscience in Psychiatry

TCPR: One of the reasons we wanted to interview you was to get insight into how we can talk to patients about the neuroscience behind their disorders. A lot of us know some of the science, but why is it good for us to learn more? Dr. Higgins: I think it’s important because having patients understand the neuroscience not only better educates them, but

Read More
Article

Treating Chronic Pain When There’s Addiction: A Primer

Topics: Addiction | Practice Tools and Tips | Psychopharmacology | Registered Articles

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics. Since our mission is to minimize suffering and optimize functioning while helpin

Read More
Expert Q&A

Using Caution While Prescribing Opioids for Pain

Topics: Addiction | Practice Tools and Tips | Psychopharmacology

CATR: I know you’ve done a lot of research around overdose deaths, both intentional and unintentional, and how this may help psychiatrists more wisely prescribe opioids for pain. Can you start by giving us a little more background on that? Dr. Bohnert: Sure. I’ll start by talking a little about overdose deaths. The study that we did in the VA wit

Read More
Expert Q&A

Assessing and Treating Psychogenic Pain

Topics: Addiction | Neuroscience in Psychiatry | Practice Tools and Tips

CATR: To start, can you give us your take on the neurological process around pain? What’s going on in the brain that causes a patient pain? Dr. Schubiner: All pain is generated by what the neuroscientists call a salience network, or as I like to call it, the danger alarm mechanism. All pain is real. It’s just a question of whether that pain is bein

Read More
Research Update

Prevalence of Fetal Alcohol Spectrum Disorder

Topics: Addiction | Research Update | Substance Abuse | Women's Issues in Psychiatry

REVIEW OF: May PA et al, JAMA 2018;319(5):474–482 New evidence suggests that the prevalence of fetal alcohol spectrum disorder is higher than previously documented. In this study, prevalence estimates were derived from 13,146 first-grade children in four U.S. communities between 2010 and 2016. The authors provide both conservative estimates (1%–5

Read More
Research Update

Is Varenicline Effective for Alcohol Use Disorder?

Topics: Addiction | Psychopharmacology Tips | Research Update | Substance Abuse

REVIEW OF: O’Malley S et al, JAMA Psychiatry 2018;75(2):129–138 Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)? So far

Read More
Research Update

Guidelines for Switching From Methadone to Buprenorphine

Topics: Addiction | Psychopharmacology Tips | Research Update

REVIEW OF: Lintzeris N et al, J Addict Med 2018. doi:10.1097/ADM.0000000000000396 Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of metha

Read More
Article

Smoking Cessation and Psychiatric Disorders

Topics: Addiction | Smoking Cessation Agents

Over the last few decades, doctors have done a better job at convincing their patients to stop smoking. But much of this improvement has been relegated to patients without mental illness. A recent study found that from 2004 to 2011, the U.S. smoking rate declined from 19.2% to 16.5% in people without mental illness, but the rate dipped only slightly in

Read More
Expert Q&A

Warning Patients on the Dangers of Cannabis Use

Topics: Addiction | Practice Tools and Tips

CATR: To start, could you tell us a little about your work around substance use disorders, and specifically your experience with cannabis and adolescents? Dr. Gray: A large focus of my career has been on doing National Institutes of Health–sponsored research into better understanding substance use disorders in young people. So, that would include a

Read More
Article

Internet Gaming Disorder: A Primer

Topics: Addiction

You’ve probably read about internet gaming disorder (IGD), and even heard about a man in Taiwan who died while continuously playing online games for 3 straight days (see http://cnn.it/2EJetN3). There’s still debate over how to classify and treat pathological gaming: Is it its own disorder, or just a symptom of another underlying mental illness? C

Read More
Research Update

Does Adolescent Vaping Lead to Cigarette Smoking?

Topics: Addiction | Research Update

REVIEW OF: Goldenson NI et al, JAMA Pediatrics 2017;171(12):1192–1199 Considering them less lethal than traditional cigarettes, many adolescents are turning to electronic cigarettes as a “safer” alternative to tobacco products. In 2016, 11% of U.S. 10th graders reported using e-cigarettes for vaping. Adolescents who vape can inhale nicotine con

Read More
Research Update

Does Moderate Alcohol Use Lead to Cognitive Decline?

Topics: Addiction | Research Update

REVIEW OF: Topiwala A et al, BMJ 2017 Jun 6;357:j2353. doi:10.1136/bmj.j2353 It’s well established that long-term, heavy alcohol use can damage the brain and can cause problems such as Wernicke-Korsakoff syndrome and alcohol-related dementia. But what about the vast majority of our patients, who drink moderately? A recent study reports an associati

Read More
Article

New Study Shows That Vivitrol Is Just as Effective as Suboxone…But Not Really

Topics: Addiction

A recent study in The Lancet appears to conclude that Vivitrol (extended release naltrexone) and Suboxone (buprenorphine/naloxone) are equally effective treatments for patients with opioid use disorders (Lee JD et al, The Lancet 2018;391(10118):309–318)—at least this is how the study has generally been reported. But a deeper dive into the study reve

Read More