Benzodiazepines in Older Adults

Topics: Addiction | Anxiety | Ashton manual | Beers criteria | Benzodiazepines | Cognitive Behavioral Therapy for Insomnia | Dementia | Fall risk | Hypnotics | Insomnia | Opioids | Overdose | Silexan | taper | Withdrawal

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

Primer: Physical Examination in Addiction Practice

Topics: Addiction | Medical Comorbidities | Prevention | Substance Use | Substance use disorders

Patients with substance use disorders (SUD) often have unaddressed medical issues. As addiction providers, we may be a patient’s only line of contact with health care personnel. Thus, keeping an eye out for medical problems could help reduce associated complications and even save a life. This article will take you through the sections of a basic physi

Screening and Prophylaxis of Infectious Diseases in Addiction Practice

Topics: Addiction | Addiction Treatment | Hepatitis | HIV | Medical Comorbidities | Prevention | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Springer: I’m an infectious disease doctor who is addiction medicine board certified as well. My background clinically is treating HIV and infectious diseases, as well as opioid use disorder (OUD) and alcohol use disorder (AUD). My research is about how to best integrate infectious disease and OUD trea

PrEP: Introduction to the Basics

Topics: Addiction | Addiction Treatment | HIV | Medical Comorbidities | Medication | Pharmacology | Prevention | Substance Use | Substance use disorders

Great strides have been made in HIV treatment and prevention during the last 2 decades, resulting in falling numbers of new HIV infections during that time span. But since 2013, the rate of new infections has mostly plateaued at just under 40,000 new infections per year (www.hiv.gov). Those at highest risk of infection remain men who have sex with men,

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

Exposure Therapy Efficacious for PTSD Co-Occurring With Alcohol Use Disorder

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Co-occurring disorders | Dual diagnosis | Prolonged exposure | Psychotherapy | PTSD | Research | Research Update | Substance Use | Substance use disorders

Review of: Norman SB et al, Efficacy 2019;76(8):791–799 Patients with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) have worse outcomes compared to patients with either diagnosis alone. Integrated approaches, in which both diagnoses are simultaneously addressed, are viewed as best practice. Providers, however, are

Varenicline and Bupropion: Soaring Again With EAGLES?

Topics: Addiction | Addiction Treatment | Bupropion | Chantix | Co-occurring disorders | Dual diagnosis | FDA Warnings | Medication | Pharmacology | Research | Research Update | Side Effects | Smoking Cessation | Smoking Cessation Agents | Substance Use | Substance use disorders | Suicidality | Suicide | Tobacco | Varenicline | Wellbutrin

Review of: Anthenelli RM et al, Lancet 2016;387(10037):2507–2520 Varenicline (Chantix) and bupropion (Zyban and others) are effective treatments for tobacco use disorder, but their use (and sales) took a big hit in 2009 when the FDA slapped both with black box warnings linking them to psychiatric complications, including suicidal ideation. Although

The COMBINE Study: A Core Paper in the Treatment of AUD

Topics: Acamprosate | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Pharmacology | Psychotherapy | Research | Research Update | Substance Use | Substance use disorders | Therapy during medication appointment | Therapy with Med Management

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Suicide Safety Planning for the Patient with Addiction

Topics: Addiction | Safety Planning | Suicide

Suicide is an epidemic in itself, with over 45,000 completed suicides in 2019 alone. It is the 10th leading cause of death in the US and the second among people ages 10–34 (Cerel J et al, Suicide Life Threat Behav 2019;49(2):529–534). With media attention focused on the growing number of accidental overdose deaths, suicide among people with addictio

The Continuing Challenge of Designer Drugs

Topics: Addiction | designer drugs | Novel drug | Substance Use

CATR: Please tell us about your background. Dr. Huestis: I’ve worn lots of hats over my career as a clinical chemist, toxicologist, and forensic toxicologist. I was at the National Institutes of Health for more than 23 years, where I had the pleasure of leading the Chemistry and Drug Metabolism Section, and for the last five years I’ve been running

Telemedicine for Addiction Treatment: Evidence and Implementation Strategies

Topics: Addiction | Addiction Treatment | pandemic | Special populations | Telehealth | Telemed | Telemedicine | Telepsychiatry

CATR: What gaps can technology fill when we work with patients with substance use disorders? Dr. Swendeman: Really, it’s about accessibility. In some ways, an in-person model where you require people to come to in-person visits could be considered a form of rationing of care. COVID-19 is creating silver-lining opportunities for telehealth to improve

Primer: Evidence-Based Psychosocial Interventions for Substance Use Disorders

Topics: Addiction | Addiction Treatment | Cognitive Behavioral Therapy | Motivational Interviewing | Psychotherapy | Substance Use Disorder

Evidence-based psychosocial interventions form a critical component of substance use disorder (SUD) treatment. However, clinicians may be less familiar with some of the newer modalities. This primer will help you make informed referrals and discuss options with your patients. Basic interventions Drug counseling Addiction counselors are the backbone o

Biomarkers of Alcohol Use

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Laboratory Testing in Psychiatry | Substance Use Disorder

We all want to know how much alcohol our patients are drinking. Asking patients directly about their drinking often generates useful information and helps build rapport, but this tactic is not always reliable. Denial and shame as well as issues related to secondary gain can sometimes contaminate self-report. Thankfully, there are many measures that can

N-acetylcysteine Not Effective for Cannabis Use Disorder in Adults

Topics: Addiction | Addiction Treatment | Cannabis | Marijuana | Substance Use Disorder

Review of: Gray KM et al, Drug and Alcohol Dependence 2017;177:249–257 N-acetylcysteine (NAC) is an over-the-counter supplement related to the amino acid cysteine. In addition to its use as an antidote for acetaminophen poisoning, it has shown evidence of efficacy in some psychiatric disorders. For substance use disorders, its primary mechanism of

Primer: Confidentiality in Addiction Treatment

Topics: Addiction | Addiction Treatment | Clinical practice | Confidentiality | HIPAA

Addiction remains stigmatized. In order to safeguard and encourage patient access to care, there are special privacy protections for individuals with substance use disorders (SUDs). This update will cover what you need to know using clinical vignettes. Clinical Scenario 1a: A 36-year-old man with heroin use disorder presents to your office for pharma

Treating Addiction in Patients Transitioning to/from Incarceration

Topics: Addiction | Addiction Treatment | Buprenorphine | Clinical practice | Incarceration | Methadone | Naltrexone | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Prison | Substance use disorders

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

New Generic Versions of Naloxone

Topics: Addiction | Addiction Treatment | Clinical practice | Medication | Naloxone | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Pharmacology

Naloxone, a rescue medication effective for reversing opioid overdoses, will soon be available in two generic forms for layperson use. Naloxone nasal spray is the generic version of branded Narcan Nasal, which currently sells for $150 for two doses. The generic version will be much cheaper. Naloxone auto-injector is the generic version of Evzio au

Opioid Use Disorder: Is There an App for That?

Topics: Addiction | Addiction Treatment | Clinical practice | Cognitive Behavioral Therapy | News of Note | Opioid epidemic | Opioid Use Disorder | Opioids | Technology

In December 2018, the FDA announced its approval of reSET-O, a new mobile medical app marketed by Pear Therapeutics to treat opioid use disorder (OUD). Mobile medical apps (MMAs) are a rapidly expanding class of smartphone apps intended to improve patient health and wellness. The FDA defines MMAs as software programs that run on smartphones and “trans

Gabapentin Enacarbil XR Efficacy Less Than Expected for AUD

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Clinical practice | extended-release | Medication | Novel Medications | Pharmacology | Psychopharmacology | Research Update

Review of: Falk DE et al, Alcohol Clin Exp Res 2019;43(1):158–169 Gabapentin enacarbil extended-release (GE-XR) (Horizant) is an extended-release version of gabapentin. GE-XR is a prodrug, meaning that once ingested it is metabolized into gabapentin. It is currently approved for treatment of postherpetic neuralgia and restless legs syndrome. It di

Can Buprenorphine Improve PTSD Symptoms?

Topics: Addiction | Addiction Treatment | Antidepressants | Buprenorphine | Co-occurring disorders | Comorbidity | Dual diagnosis | Medication | Opioid Use Disorder | Pharmacology | PTSD | Research Update | SSRIs

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal