Substance Use Disorder

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.

Are a history of complicated pneumonia and possible obstructive sleep apnea part of the DSM-IV exclusionary criteria for potential participants in anesthesia-assisted opioid withdrawal? How many alcoholic drinks a week does it take for a woman to be considered an at-risk drinker? These and more in this week's quiz.

A joint study by researchers at two universities reported that the majority of people with alcohol problems who seek out clergy for help have or will also use professional mental health services at some point in their recovery process.

From 19th century French impressionists to current-day “rockers,” it has always been a loosely held belief that creative genius encompasses (even embraces) substance use. But a recent study found that substance use impedes artistic creativity.

A recent essay by Michael W. Kahn, MD, explores whether psychiatrists are going too far in denying patients’ requests for drugs. When first year psychiatry residents were asked how they would react to a request from a patient for narcotic painkillers or antianxiety medications, the general consensus was that they would do no harm by playing it safe and would not provide the requested drug.

Epidemiological studies show that, 4% to 5% of the general population have severe ADHD. Of this number, half have a comorbid substance use disorder. The aim of this article is to help physicians understand and manage this challenging combination of comorbidities.

The impact of FDA alerts and label warnings was examined in 2 recently published studies of antipsychotic drug use. In one study, researchers gauged physician response to the 2005 warning of increased mortality with antipsychotic use in elderly patients with dementia, and in the other study, researchers determined whether recommended safeguards were implemented following the 2003 advisories on adverse metabolic effects of second-generation antipsychotics.

DSM-IV provides separate categories for Substance Abuse and Substance Dependence. The typical substance abuser is someone who gets into recurrent, but intermittent, trouble as a consequence of recreational binges. This is in contrast to the continuous and compulsive pattern of use that is typical of DSM-IV Substance Dependence.

An overview of the critical issues involved in overcoming personal and organizational barriers to help substance abusers quit smoking.

This article emphasizes core philosophies and components of effective dual disorder programs.

The high rate of comorbid substance abuse in women with bulimia nervosa (BN) has remained consistent in the literature. This article reviews the prevalence of substance abuse in BN and summarizes treatment approaches for persons with BN and comorbid substance abuse.

Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.

The rising prevalence and dispersion of obesity in North America in the past decade is analogous to a communicable disease epidemic. Longitudinal and cross-sectional associations between major depressive disorder, schizophrenia, and obesity have been established. Existing evidence also indicates that there is an association between bipolar disorder and obesity.

The leading edge of the baby boom generation is rapidly moving into the treatment realm of geriatric psychiatry. As a cohort, baby boomers experimented more with alcohol and illicit drugs than did previous generations.

Addiction-related prevention, research, and treatment have remained important areas of concentration in the field of psychiatry.