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

Coffee: Healthy Study Aid or the Addiction We Hate to Acknowledge?

Topics: Addiction | Caffeine | Free Articles | Registered Articles | Substance Abuse

Caffeine permeates our society. It comes in many forms, including coffee and increasingly popular energy drinks. We consume it, and so do our patients. So, is it a harmless habit or a potentially harmful addiction? Let’s take a sip and find out. Is it addictive? The WHO in ICD-10 recognizes the diagnosis of substance dependence due to caffeine, an

Note From the Editor-in-Chief

Topics: Addiction | Practice Tools and Tips

Addiction spares no age group, but it often goes undetected in older adults age 65 or older, and its treatment poses age-specific challenges. In this issue, we interview Dr. David Oslin to unpack some of these challenges and talk about screening tools, physiological changes, and psychosocial stressors, as well as general treatment approaches in older ad

Alcohol Use Disorder Meds in Older Adults

Topics: Addiction | Substance Abuse

How should we employ pharmacotherapies for alcohol use disorder (AUD) in older adult patients? There are three FDA-approved medications (acamprosate, disulfiram, and naltrexone) and two other commonly used off-label agents (gabapentin and topiramate). But these medications have no established guidelines geared specifically to older adults. In this pr

Substance Use Disorder in Older Adults

Topics: Addiction | Practice Tools and Tips | Substance Abuse

CATR: Let’s start with diagnosis. Are there specific challenges in diagnosing substance use disorder (SUD) in older adults? Dr. Oslin: There definitely are, and DSM criteria can be hard to apply. Older adults are more likely to drink at home, much more likely to have medical problems, and may have interpersonal issues, but they will likely have fewer

Low-Risk Drinking Limits: What Should We Tell Older Adult Patients?

Topics: Addiction | Substance Abuse

How much can our older patients safely drink? And what does “safe” or “low-risk” drinking actually mean? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the branch of the NIH that focuses on problems related to alcohol, has released guidelines for low-risk drinking limits in older patients. Let’s take a look at their r

Opioids Not Superior to Other Medicines for Some Chronic Pain

Topics: Addiction | Free Articles | Research Update | Substance Abuse

REVIEW OF: Krebs EE et al, JAMA 2018;319(9):872–882 Rising rates of opioid overdose deaths have sounded alarm bells over opioid prescribing practices for chronic pain. Unfortunately, and despite the absence of quality data on their risks vs benefits, long-term opioid management has remained a common approach to managing chronic musculoskeletal pain

Sleep Apnea in Patients With Substance Use Disorders: A Primer

Topics: Addiction | Sleep Disorders | Substance Abuse

A 55-year-old male patient you have been treating for alcohol use disorder has been struggling with withdrawal following detox. He tells you his spouse is complaining about his severe and disruptive snoring, and he says he feels “wiped out” all day, even falling asleep at work. He then admits that, to stay alert, he has been regularly taking Adderal

Treating Insomnia With Addiction

Topics: Addiction | Sleep Disorders | Substance Abuse

CATR: With substance use disorders (SUDs) that are comorbid with chronic insomnia, what would you say are some of the main treatment challenges? Dr. Hermes: The first thing I’d say is that chronic insomnia has a high comorbidity rate with SUDs as well as general psychiatric conditions and medical conditions, including chronic pain, COPD, heart diseas

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

Adolescents With ADHD and Substance Use Disorders: A Primer

Topics: Addiction | ADHD | Child Psychiatry | Registered Articles | Substance Abuse

You are evaluating a 16-year-old boy referred for mandated substance use treatment by his high school, where he was found drinking alcohol and smoking cannabis with a friend in the restroom. As you gather his history, he says, “One doctor told me I have ADHD. That’s why I smoke pot—it helps me focus. But I think I’d do better with some Adderall.

Talking to Parents and Adolescent Patients About Substance Use

Topics: Addiction | Child Psychiatry | Practice Tools and Tips | Substance Abuse

CATR: To start us off, how does addiction differ in adolescents vs adults? Dr. Quigley: In adolescents it can be subtle. For example, there are culturally normative behaviors with alcohol and cannabis use, and kids get missed because people write it off as “just partying.” They miss the fact that the substance use has become extremely impairing. Ad

The Neuroscience Behind Addictions and SSRIs

Topics: Addiction | Neuroscience in Psychiatry

TCPR: One of the reasons we wanted to interview you was to get insight into how we can talk to patients about the neuroscience behind their disorders. A lot of us know some of the science, but why is it good for us to learn more? Dr. Higgins: I think it’s important because having patients understand the neuroscience not only better educates them, but

Treating Chronic Pain When There’s Addiction: A Primer

Topics: Addiction | Practice Tools and Tips | Psychopharmacology | Registered Articles

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics. Since our mission is to minimize suffering and optimize functioning while helpin

Using Caution While Prescribing Opioids for Pain

Topics: Addiction | Practice Tools and Tips | Psychopharmacology

CATR: I know you’ve done a lot of research around overdose deaths, both intentional and unintentional, and how this may help psychiatrists more wisely prescribe opioids for pain. Can you start by giving us a little more background on that? Dr. Bohnert: Sure. I’ll start by talking a little about overdose deaths. The study that we did in the VA wit

Assessing and Treating Psychogenic Pain

Topics: Addiction | Neuroscience in Psychiatry | Practice Tools and Tips

CATR: To start, can you give us your take on the neurological process around pain? What’s going on in the brain that causes a patient pain? Dr. Schubiner: All pain is generated by what the neuroscientists call a salience network, or as I like to call it, the danger alarm mechanism. All pain is real. It’s just a question of whether that pain is bein

Prevalence of Fetal Alcohol Spectrum Disorder

Topics: Addiction | Research Update | Substance Abuse | Women's Issues in Psychiatry

REVIEW OF: May PA et al, JAMA 2018;319(5):474–482 New evidence suggests that the prevalence of fetal alcohol spectrum disorder is higher than previously documented. In this study, prevalence estimates were derived from 13,146 first-grade children in four U.S. communities between 2010 and 2016. The authors provide both conservative estimates (1%–5

Is Varenicline Effective for Alcohol Use Disorder?

Topics: Addiction | Psychopharmacology Tips | Research Update | Substance Abuse

REVIEW OF: O’Malley S et al, JAMA Psychiatry 2018;75(2):129–138 Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)? So far

Guidelines for Switching From Methadone to Buprenorphine

Topics: Addiction | Psychopharmacology Tips | Research Update

REVIEW OF: Lintzeris N et al, J Addict Med 2018. doi:10.1097/ADM.0000000000000396 Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of metha

Smoking Cessation and Psychiatric Disorders

Topics: Addiction | Smoking Cessation Agents

Over the last few decades, doctors have done a better job at convincing their patients to stop smoking. But much of this improvement has been relegated to patients without mental illness. A recent study found that from 2004 to 2011, the U.S. smoking rate declined from 19.2% to 16.5% in people without mental illness, but the rate dipped only slightly in