Under the Pandemic Influence

Topics: Addiction Treatment | COVID-19 | pandemic

Stay-at-home orders in many US states, which began in early 2020, have been associated with increased alcohol sales, particularly via online outlets. The World Health Organization issued a warning in April 2020 that alcohol use may potentially exacerbate poor health during the coronavirus disease 2019 (COVID-19) pandemic. How has the pandemic influenced

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

Updated Guidelines for Treating Opioid Use Disorder

Topics: Addiction Treatment | Buprenorphine | Medication | Methadone | Opioid epidemic | Opioid Use Disorder | Pain | Pharmacology

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

Highlights From This Issue

Topics: Addiction Treatment

Overdose education with naloxone distribution, syringe exchange, fentanyl testing, and pre-exposure prophylaxis for HIV prevention are strategies that addiction providers can use in practice to reduce harm from substance use. The CDC recommends naloxone prescriptions be offered to patients at risk for overdose, including those with opioid use disorde

New Hope: CBT for Internet and Computer Game Addiction

Topics: Addiction Treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Technology

Review of: Wölfling K et al, JAMA Psychiatry 2019;76(10):1018–1025 While many of us likely spend far too much time on our various devices—whether for fun or for work—between 0.3% and 1% of the general population might qualify for an internet gaming disorder (Przybylski AK et al, Am J Psychiatry 2017;174(3):230–236). Defined as excessive preo

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

Treating Alcohol Use Disorder

Topics: Addiction Treatment | Alcohol | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Substance Use Disorder | Therapy with Med Management

CATR: Can you tell us about the role of medications for alcohol use disorder (AUD)? Dr. Arias: Medications are a very important part of AUD treatment. They can and should be used as a first-line treatment in any reasonable medical setting—primary care or psychiatry, or a specialty addiction setting. Unfortunately, very few patients ever receive them.

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

Disulfiram: An Underused Strategy for Alcohol Use Disorders

Topics: Abstinence | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Disulfiram | Free Articles | Psychopharm Myths

Alcohol ranks third among preventable causes of death in the US, but it is by far the most undertreated. Fewer than 8% of people with alcohol use disorders (AUDs) receive treatment for their disease, and only a minority of them receive FDA-approved medications. Those medications are acamprosate (Campral), naltrexone (Vivitrol, ReVia), and disulfiram (An

Introducing CRAFT: A Non-Confrontational Intervention We Can Recommend to Families

Topics: Addiction Treatment | Intervention

How should families help their loved ones who are struggling with addiction? Should they be accommodating, firm, or confrontational? The Community Reinforcement and Family Training (CRAFT) approach is a good strategy that you should become familiar with. Before we describe CRAFT, though, you should know about two other frequently used approaches to h

Becoming a Board-Certified Addiction Clinician

Topics: Addiction Treatment | Board Certification | Practice Tools and Tips

CATR: To start off, could you tell us why a psychiatrist or any other physician would want to be board-certified in addiction? Dr. Weaver: Patients with addiction are common in psychiatric or any other practice. You’re going to see patients who have these issues, so it’s good to be prepared and able to focus on treating addiction, as well as to be