Substance Use Disorder

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.

Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.

There have been numerous definitions of culture. Dwight Heath1 offers a simple definition: "It [culture] is a system of patterns of belief and behavior that shape the worldview of the member of a society. As such, it serves as a guide for action, a cognitive map, and a grammar for behavior."

The Substance Abuse Handbook offers a comprehensive, clinically oriented approach to the treatment of addictive disorders. It contains a wealth of useful information, ranging from causes of addiction to different modes of treatment.

Book Review

Although there are many treatments and interventions available for drug abuse and dependence, few persons with substance use disorders actually use them, a new survey reports. The National Epidemiologic Survey on Alcohol and Related Conditions, conducted by scientists from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, was published in the May 2007 issue of the Archives of General Psychiatry. The survey used face-to-face interviews with over 43,000 US adults aged 18 years or older.

There are important distortions in the article "Substance Abuse in Women: Does Gender Matter?" (Psychiatric Times, January 2007, page 48). My concerns regard the political assumptions made (rather than those based on science) that put a spin on data rather than letting the data stand alone.

The highly readable and informativesecond edition of Substance Use Disorders,by Stuart Gitlow, is a valuablehandbook for treatment providers ofall specialties.

In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect.

SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse (Part 1)

Psychotic disorders are a group of syndromes characterized by positive symptoms, including hallucinations, delusions, and thought disorder; and negative symptoms, including mood symptoms, social withdrawal, and reduced motivation. Cognitive deficits also appear with psychotic disorders. Psychotic disorders rank 22nd in the World Health Organization's list of worldwide causes of disability. This ranking is adjusted for the relatively low lifetime prevalence rate for psychosis; the perceived burden of the disease on those affected with psychotic disorders, as well as their relatives and caregivers, is much higher.

Substance use disorder (SUD) plays a prominent role in the epidemiology, cause, and course of mental illness. Of the more than 5 million Americans with comorbid mental illness and SUD, fewer than half received treatment at either a specialty mental health or substance abuse treatment facility.

The prevalence of substance use disorders in patients with schizophrenia is greater than the rate observed in the general population, with a dramatic increase since the 1970s. Several theories exist to explain the high rate of comorbidity. The "self-medication" hypothesis suggests that persons may abuse substances to treat underlying psychotic symptoms or adverse effects of medications commonly used to treat schizophrenia.

Borderline personality disorder (BPD) and substance use disorder (SUD) often co-occur. Comorbid BPD and SUD is related to a variety of severe adverse outcomes.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

There has been a growing awareness in recent years of the importance of gender in medical treatment and research. While much past research in addiction focused on men, there is now recognition that biologic and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders.