Warning Patients on the Dangers of Cannabis Use

Topics: Addiction | Practice Tools and Tips

CATR: To start, could you tell us a little about your work around substance use disorders, and specifically your experience with cannabis and adolescents? Dr. Gray: A large focus of my career has been on doing National Institutes of Health–sponsored research into better understanding substance use disorders in young people. So, that would include a

Internet Gaming Disorder: A Primer

Topics: Addiction

You’ve probably read about internet gaming disorder (IGD), and even heard about a man in Taiwan who died while continuously playing online games for 3 straight days (see http://cnn.it/2EJetN3). There’s still debate over how to classify and treat pathological gaming: Is it its own disorder, or just a symptom of another underlying mental illness? C

Does Adolescent Vaping Lead to Cigarette Smoking?

Topics: Addiction | Research Update

REVIEW OF: Goldenson NI et al, JAMA Pediatrics 2017;171(12):1192–1199 Considering them less lethal than traditional cigarettes, many adolescents are turning to electronic cigarettes as a “safer” alternative to tobacco products. In 2016, 11% of U.S. 10th graders reported using e-cigarettes for vaping. Adolescents who vape can inhale nicotine con

Does Moderate Alcohol Use Lead to Cognitive Decline?

Topics: Addiction | Research Update

REVIEW OF: Topiwala A et al, BMJ 2017 Jun 6;357:j2353. doi:10.1136/bmj.j2353 It’s well established that long-term, heavy alcohol use can damage the brain and can cause problems such as Wernicke-Korsakoff syndrome and alcohol-related dementia. But what about the vast majority of our patients, who drink moderately? A recent study reports an associati

New Study Shows That Vivitrol Is Just as Effective as Suboxone…But Not Really

Topics: Addiction

A recent study in The Lancet appears to conclude that Vivitrol (extended release naltrexone) and Suboxone (buprenorphine/naloxone) are equally effective treatments for patients with opioid use disorders (Lee JD et al, The Lancet 2018;391(10118):309–318)—at least this is how the study has generally been reported. But a deeper dive into the study reve

Helping Patients With Stigma and Addiction

Topics: Addiction | Free Articles | Practice Tools and Tips

CATR: To start, can you please tell us a little more about your work at Harvard and Mass General? Dr. Kelly: Sure. I’m a clinical psychologist by training, and for the past 20 years, I have spent a lot of time researching the addiction treatment and recovery processes. I’ve looked at the effectiveness of different treatments, their mechanisms, an

Prescribing Gabapentin for Substance Use Disorders

Topics: Addiction

Gabapentin (Neurontin) is a “novel anticonvulsant” and is FDA indicated for partial seizures and post-herpetic neuralgia. But the drug has long been heavily marketed to psychiatrists to treat a range of conditions from bipolar disorder to anxiety to alcohol withdrawal. It’s often seen as a “non-addictive” ­off-label drug useful for treating a

Interventions for Treatment or Prevention of Alcohol Hangover: Systematic Review

Topics: Addiction | Research Update

REVIEW OF: Jayawardena R et al, Hum Psychopharmacol 2017;32(3). Epub 2017 Jun 1. As clinicians, we’re more interested in preventing excessive drinking than curing hangovers. But it’s always nice to have some helpful advice for patients, which we found in a recently published literature review of clinical trials of hangover treatments. The auth

Neurostimulation for Opioid Withdrawal Symptoms

Topics: Addiction | Research Update

REVIEW OF: Miranda A and Taca A, Am J Drug Alcohol Abuse 2017:1–8 A challenging barrier for patients with opi­oid use disorders is the discomfort that can occur during the “induction phase” of their treatment, which is the period between discontinuation of opioids and initiation of medication-assisted therapy (MAT). Difficulties with induction

Substance Use in Pregnancy: What to Tell Patients

Topics: Addiction | Registered Articles | Substance Abuse | Women's Issues in Psychiatry

As an OB/GYN physician with a special interest in opioid use disorders during pregnancy, I see many women of childbearing age who are struggling with a substance use disorder. Some of these women are contemplating pregnancy, while others are already pregnant. I often collaborate with psychiatrists when treating these women, and I enjoy sharing knowledge

Pregnancy and Substance Use Disorders

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

CATR: As both an addiction medicine physician and an obstetrician, you are in a unique position to advise other physicians about controlled substance use and pregnancy. What would you say are some of the most frequent questions you’re been asked by other physicians? Dr. Christensen: Typically, the most frequent problem that I’m referred is the preg

Can Just 11 Minutes of Mindfulness Training Reduce Alcohol Consumption?

Topics: Addiction | Research Update | Substance Abuse

REVIEW OF: Kamboj SK et al, Int J Neuropsychopharmacol 2017;20(11):936–947 Mindfulness is a growing trend in mental health treatment, but it often requires hours of practice to become proficient. What if you could provide your patients with an introductory mindfulness lesson in less than 15 minutes and see meaningful reductions in their risky drink

Detox: An Overview

Topics: Addiction | Pharmacology Tips | Psychotherapy | Substance Abuse

Detox (also known as “medically supervised withdrawal”) refers to treatment to help patients withdraw from substances that cause physical dependence, such as alcohol, sedative-hypnotics, and opioids. But detox is far more than a several-day process of ridding the body of an addictive substance. It should be considered an important component in the o

Cannabis Use Disorder Treatment

Topics: Addiction | Pharmacology Tips | Psychotherapy | Substance Abuse

CATR: So, what do you feel is the big-picture challenge of treating heavy cannabis users? Dr. Hill: A big challenge is helping heavy users understand that cannabis use disorder is a real thing. It is hard for people to appreciate the risks that are associated with heavy use when they hear about the medical benefits and the recreational aspects of can

Kratom: A Primer for Clinicians

Topics: Addiction | Substance Abuse

Kratom (Mitagyna speciose) is a tropical evergreen tree in the coffee family whose leaves have been used for centuries in South Asian countries as a stimulant and pain reliever. Recently, kratom has entered US and European markets and is now sold in various forms, both online and at local head shops. Because kratom possesses opioid-like properties, b

How Effective Is Tramadol for Opioid Withdrawal?

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

Review of: Dunn K et al, JAMA Psychiatry 2017. doi:10.1001/jamapsychiatry.2017.1838. [Epub ahead of print] Opioid withdrawal protocols often rely on a buprenorphine taper, but other medications are regularly used either in addition to or in the place of buprenorphine. In particular, tramadol ER, a mild opiate, may be effective and was recently studie

Take The CME Post-Test for Detox, CATR, September/October 2017

Topics: Addiction | Pharmacology Tips | Psychotherapy | Research Update | Substance Abuse

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 2 CME credits. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logg

When AA Is Not the Answer: SMART Recovery and Other 12-Step Alternatives

Topics: Addiction | Psychotherapy | Substance Abuse

Doctor: You might attend an AA meeting, if you’ve never been. They’re widely available, which makes it easy to find one nearby. Patient: I agree I drink too much, but I don’t like all that “higher-power” stuff I’ve heard about AA meetings. I don’t think they would help me. Doctor: Understood. No approach works for everyone. Fortunately,

Technology-Assisted Care for Substance Use Disorders

Topics: Addiction | Psychotherapy | Substance Abuse

CATR: What are some of the online treatment modalities available for psychiatrists to incorporate into their substance abuse practices? Dr. Nunes: Cognitive behavioral therapy (CBT) is the main modality available now. CBT lends itself to online treatment because it consists of a set of clearly defined techniques that can be taught in an online, multi

How Low Can You Go? Ultra-Low Magnitude Reinforcers in a Methadone Clinic

Topics: Addiction | Psychotherapy | Substance Abuse

REVIEW OF: Kropp F et al, J Subst Abuse Treat 2017;72:111–116 Contingency management (CM) programs are often effective, but they can be expensive, with typical incentives costing $900–$3,000 for a 12-week program. Expensive CM programs are referred to as “high magnitude.” In this new study, researchers tested an “ultra-low magnitude” prog