Addiction & Substance Use

Many will recall “The Decade of the Brain,” when President George H.W. Bush declared that the 1990s would be dedicated to research on neuroscience. If there were landmark findings from that decade, I’m not sure what they were.

The recent death of Amy Winehouse has brought the question of why some people get addicted to alcohol and/or drugs and others don’t.

Those of you who have been following the SVP controversy know that "Paraphilia NOS, nonconsent" (PNOS) is a fake diagnosis that is losing traction as justification for committing rapists to psychiatric hospitals.

Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.

This article addresses the epidemiology, diagnosis, and treatment of mild TBI among combat veterans, with a particular focus on blast injury and the presence of comorbid posttraumatic stress disorder (PTSD).

Most military families successfully adapt to a service member's deployments for military duties. Nevertheless, almost a decade of wartime stress associated with the current wars in Iraq and Afghanistan has presented unprecedented challenges for military families.

Which tool is helpful in screening for sexual addiction? Is the symptom severity in women treated for substance abuse generally equivalent to that of males? Structural abnormalities in which brain areas have been associated with substance abuse? These questions and more in this quiz.

During the past year, I have been involved as an expert witness for the defense in 14 SVP cases (tried in California, Washington, and Iowa). My role has been to clarify what is meant by the wording of the Paraphilia section in DSM-IV. And it certainly does badly need explaining.

REMS programs are meant to focus on drugs that are associated with special risks that the FDA does not feel are sufficiently addressed by the standard prescribing information.

Medicine is not about making us feel better about ourselves-although this doesn’t hurt. In the case of addicts, it is about looking at the root cause of addictions and seeing the person-not just the addict-in front of us.

According to the American Foundation for Suicide Prevention, more than 34,000 Americans die by suicide annually. Of these, 10% have never been given a psychiatric diagnosis.

Alfred Freedman was an eminent psychiatric educator, a leader of his profession, and a man willing to challenge public prejudice. He was also one of my closest friends.

If psychiatry reduces or abandons its engagement with psychology and social science in understanding and treating mental disorders and focuses predominantly on the biological factors of mental disorders, what will our role as psychiatrists be?

The majority of the literature focuses on prenatal and postnatal depression in mothers, and little attention has been given to the incidence of prenatal and postpartum depression in fathers.

Marsha Linehan is the creator of Dialectical Behavior Therapy (DBT)-the best available method for helping self destructive people help themselves. I have never been more admiring of her than I am at this moment.

There should be no quarrel over the reality of severe CFS as an instantiation of genuine disease, just as schizophrenia and major depression constitute real disease.

I just attended the 40th year reunion of my medical school class at Yale. As is common at these 5-year reunions, we compare our careers and the progress of medicine, although this time more of the focus seemed to be on our personal lives and our new Medicare cards.

Depression and alcoholism treatment requires the proper use of medication and psychosocial interventions, as well as a solid doctor-patient relationship and a commitment to treat both disorders.

Advances in the fields of neuropsychological assessment and neuroimaging have enormously expanded our knowledge about the profile and severity of cognitive deficits in patients with substance use disorders.

Nonadherence to treatment by patients represents one of the most prevalent and important challenges to the practice of psychiatry.

The COMBINE study was only one trial designed by academics to maximize internal scientific validity. It excluded individuals with other significant psychiatric and medical illnesses (more often the rule than the exception in some clinical settings)-individuals deemed too severely ill or who needed hospitalization.

In this Special Report, Helen M. Pettinati, PhD, and William D. Dundon, PhD, discuss prevalence, assessment, clinical features, and treatment issues with respect to individuals with co-occurring major depression and alcohol dependence.

I just received a very important email from Dr Dayle Jones who chairs the DSM-5 Task Force of the American Counseling Association (ACA). The ACA has provided a much needed wake-up call for the American Psychiatric Association.

If you’ve ever wondered what psychoanalytic treatments are like, The King’s Speech provides an unusually good cinematic representation of a psychoanalytic therapy.

A report of dropoffs of elderly individuals at hospitals, elderly persons being reported for socially inappropriate behavior, and an increase in 911 calls concerning elderly relatives with dementia attacking family members and caregivers.

Researchers are developing a scale to measure a clinically identified emotional “trigger state” that puts individuals with suicidal ideation at increased risk of acting on their ideations.

Psychiatry is a wonderful specialty. We have highly effective medication and psychotherapy tools. Forty years of accumulated clinical research have given us a pretty clear idea of optimal treatment guidelines. With an accurate diagnosis and an appropriate treatment, most of our patients benefit greatly and many recover completely.

Excellence in psychopharmacology demands sensitivity to the associated ethical considerations. The key considerations of psychiatry are both complex and dynamic, and psychiatrists who develop and refine their ethics skill set will be in a better position to anticipate and respond to ethical dilemmas as they arise in their practice.

Like every drug or technology that has therapeutic value, MDMA (3,4-methylenedioxymethamphetamine) has potential risks and benefits. Unlike most other drugs under clinical investigation, MDMA has a complex and controversial history that has delayed dispassionate scientific investigation into its therapeutic use.

The only question is whether Congress will cut the mental health block grant again, in 2012-and by how much.