SUBSTANCE ABUSE AND ADDICTION Advances and Challenges in Addiction Medicine

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.

Despite the advances, however, we continue to face major clinical challenges. One area ripe for development is that of understanding and addressing the interplay of culture and substance use. In their intriguing article, Abbott and Chase offer a starting point. Focusing on North American cultural groups, they review the historical development of substance use and abuse. They go on to offer some guidelines for culturally informed screening, assessment, and treatment.

Another challenge that confronts us is the seemingly endless variety of misused substances that apparently take turns coming to the fore, then receding, thus constantly changing the face of addiction. Usually, different regions of the United States experience spikes in the abuse of various substances at different times. You do not have to be a baseball fan to know that there is a lot of concern about the use of anabolic androgenic steroids, especially among young athletes. As both a baseball fan (Boston Red Sox) and a clinician, I find the article by Westreich most timely. He reviews the pharmacology of anabolic androgenic steroids, as well as their prevalence, before going on to discuss the psychiatric manifestations of steroid use and offering suggestions about prevention and treatment.

The article by Bukstein provides some excellent insights into the world of adolescent prescription drug misuse. The author lays out compelling statistics, as well as interesting information about adolescent perceptions of drugs, motivations for drug use, and sources of drugs. He finishes with some excellent, practical, clinical guidelines.

Stories of methamphetamine and home "meth labs" have frequently been in the news in recent years. In the final article, Hill offers a masterful overview of the methamphetamine menace. He provides a clinically focused view of the problem. After reviewing the epidemiology and public health implications, he thoroughly catalogues treatment trials discussing both the mixed results with different classes of medications and the more hopeful findings with psychosocial interventions.

These 4 articles provide readers an opportunity to update their knowledge and clinical skills in several contemporary areas of addiction treatment. You will find the articles not only interesting but also helpful in treating patients who present with addictive disorders.