Substance Use Disorder

Can drugs be categorized as good (eg, medicinal), bad (eg, recreational with deleterious side effects and addiction issues), or is there a middle ground? That was the underlying theme in a lecture at PsychCongress, “Perils and Promise of Psychoactive Drugs: A Focus on Harm Reduction Psychiatry.”

If you could talk to a clinician-in-training about how they can better help people suffering from addiction, what would you say? A Q&A between Arjune Rama, MD, and comic Marc Maron.

Here, a psychiatrist certified by the American Board of Addiction Medicine discusses new treatment criteria for addiction.

Both the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry have identified substance abuse as a top risk factor for suicide in youths.

If our survey on medical cannabis is any indication, psychiatrists are widely-and deeply-divided on whether and how marijuana should be used in clinical practice. You can read the results here.

As we accumulate a greater war chest of patient experiences, we can better apply our skills as physicians to fill a space once occupied with alcohol-lubricated decision-making with smooth yet sober coping strategies.

Calling all psychiatrists: we conducted a survey of your opinions about prescribing medical cannabis and invite you to view the results.

Quick . . . name a class of prescription medications that, by most evidence, appears to be overprescribed and abused and the use of which has resulted in an increasing number of emergency department visits. If you said "opioids," you would be right.

It is clear that the prognosis for schizophrenia is much better when patients achieve drug abstinence, including in the domains of depression, quality of life, and community integration.

A parent's heavy drinking can increase a child's risk of substance use disorder.

As we are faced with a growing population of older adults, a better understanding of the issues that they confront is crucial.

How can clinicians reliably identify comorbid drug and alcohol use disorders in patients with anxiety disorders?

How would you rate the integration of mental health treatment with addiction treatment? Where is there room for improvement?

The report notes that pain is a significant public health problem that affects more than 100 million Americans, costs our society at least $560 to $659 billion annually, and can be severely detrimental to the lives of sufferers.

Substance use disorders are associated with significant morbidity and mortality that affects individuals and their families. Preventing the onset of an SUD in adolescence remains a critical area of clinical and public health significance.

Anxiety disorders occur in 18% to 28% of the US general population during any 12-month period. In anxiety disorder, there is a 33% to 45% 12-month prevalence rate for a comorbid substance use disorder (SUD).

In this article, we attempt to leverage state-of-the-art research findings to provide empirically informed perspectives and practices related to these issues.

What is your experience with patients who may decide to quit multiple substances simultaneously? Is it overambitious?

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.

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.

When it comes to analgesics, many options and various factors must be weighed to make the best choice for each patient.

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.

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.

Patients with anxiety disorders who self-medicate with alcohol or drugs may be increasing their risk for developing incident substance use disorders, according to a study presented at the American Psychiatric Association’s recent annual meeting.

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.

DSM-IV, published in 1994, did not include a cannabis withdrawal disorder diagnosis. DSM-IV-TR clearly stated the reason for the omission: “Symptoms of possible cannabis withdrawal . . . have been described in association with the use of very high doses, but their clinical significance is uncertain.”1

Emerging research suggests that some individuals with particular types of substance use and abuse may be more likely to engage in suicidal behaviors. For example, those who use opiates, cocaine, or sedatives may have a noticeably higher risk of suicide than those who use other drugs.

Recently, the Substance Use Disorder Work group of the DSM-5 announced the inclusion of “craving” in the diagnostic criteria for all substance use disorders despite its lack of empirical support from the very analyses conducted by that Workgroup. In addition, no detailed literature review supports the decision to make “craving” a core symptom of Substance Use Disorder syndromes.

A recent study reports that patients have a greater chance of survival when given opiate substitution treatment (OST) for over 12 months. Although there has been a 2-fold increase in opiate prescriptions in the past 10 years, the mortality rate from OST has fallen, making it a viable treatment for opiate abusers.