Should Prolonged Abstinence From Alcohol Be Required Before Liver Transplant?

Topics: Alcohol use disorder | alcohol- associated liver disease | consult-liaison | medical comorbidity | transplant surgery

REVIEW OF: Herrick-Reynolds KM et al, JAMA Surg 2021;156(11):1026–1034 STUDY TYPE: Retrospective cohort study Traditionally, patients with alcohol-related liver disease are told that they have to be sober for at least six months before they can have a liver transplant (LT). The theory is that if patients don’t undergo a period of abstinence, t

Does Pioglitazone Lead to Reduced Alcohol Use?

Topics: Alcohol use disorder | Medication

REVIEW OF: Dieperink E et al, Am J Addict 2021;30(6):570–577 STUDY TYPE: Retrospective cohort study Some preclinical data suggest that pioglitazone (Actos), a medication commonly prescribed for type 2 diabetes, might be helpful for the treatment of addictive disorders, including alcohol use disorder (AUD). The purported mechanism is peroxisome p

Treating Agitation in ICU Patients with AUD?

Topics: Agitation | Alcohol use disorder | Delirium | Withdrawal

REVIEW OF: Vourc’h M et al, JAMA 2021;325(8):732–741 STUDY TYPE: Randomized clinical trial It’s known that people who drink unhealthy amounts of alcohol are more likely to get agitated if they’re admitted to the ICU. What to do about it is less well understood. In this study, researchers reasoned that mimicking some of alcohol’s effects

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

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

Personal Privacy Versus Public Safety: Addiction Among Health Professionals

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

CATR: Tell us how your interest in addiction came about. Dr. Earley: When I started working in the world of addiction treatment 35 years ago, there wasn’t much specific training. I was trained as a neurologist and always had an interest in patients with substance use disorders. Ultimately, I decided to shift my specialty and wound up cobbling togethe

Learning From the Successes of Physician Health Programs

Topics: Abstinence | Addiction Treatment | Alcohol use disorder | Legal issues | Opioid Use Disorder | Special populations

The rate of substance use disorders among physicians is around the same if not slightly higher than in the general population. Impaired physicians, however, are a public health threat, and in most states there is mandated reporting of impaired ­physicians (­Mossman D, Current Psychiatry 2011; 10(9):67–71). So what is to be done for an addicted or im

Real-World Alcohol Use Disorder Treatment

Topics: Alcohol use disorder | Comorbidity | Dual diagnosis | Psychopharmacology | Psychotherapy

CATR: Please tell us about yourself. Dr. Petrakis: I’m an addiction psychiatrist, professor at Yale School of Medicine, and the Chief of Mental Health for the VA Connecticut Healthcare System. I have several research focuses, one of which is the treatment of individuals with comorbid psychiatric illness and alcohol use disorder (AUD). CATR: We kno

Alcohol-Induced Liver Disease

Topics: Alcohol related liver disease | Alcohol use disorder | Laboratory Testing in Psychiatry

CATR: Many non-specialists find the jargon of the liver field confusing. Can we start by reviewing the relevant terminology that clinicians should be familiar with? Dr. Bataller: The best way to do that is by reviewing the natural history of alcohol-related liver disease. Most people who drink excessively accumulate fat in the liver; this is an early s

Medications for Alcohol Use Disorder: An Overview

Topics: Alcohol use disorder | Medication | Psychopharmacology

Alcohol use disorder (AUD) is the most common substance use disorder by far, with a lifetime prevalence of nearly 30%. It is also vastly undertreated; less than 20% of people with AUD ever receive treatment (Grant BF et al, JAMA Psychiatry 2015;72(8):757–766). To make matters worse, there are only three FDA-approved medications for AUD: disulfiram, ac

Meds for Alcohol Use Disorders

Topics: Alcohol use disorder | Naltrexone | observational study | Psychopharmacology

REVIEW OF: Heikkinen M et al, Addiction 2021;116(8):1990–1998 STUDY TYPE: Cohort study In the US, only 9% of patients diagnosed with alcohol use disorder (AUD) are prescribed AUD medication (Kranzler HR and Soyka M, JAMA 2018;320(8):815–824). A Swedish study provides evidence that further illuminates the potential harms from this lack of treat

Do We Need to Be Face-to-Face to Treat Alcohol Use Disorder?

Topics: Alcohol use disorder | Quality of care | Randomized controlled trial | Telemedicine

Review of: Johansson M et al, Addiction 2020 Sep 24. Epub ahead of print. The COVID-19 pandemic has highlighted the potential value of virtual treatment. This may be particularly useful for individuals with alcohol use disorder (AUD), for whom shame and stigma may limit engagement and/or retention in traditional forms of face-to-face treatment. Howev

When to Stop Addiction Treatment: How Long Is Enough?

Topics: Addiction Treatment | Alcohol use disorder | Buprenorphine | Clinical practice | Medication adherence | retention

When a patient with a substance use disorder (SUD) has that “reachable moment” and/or recognizes the need to seek help, we know the importance of decreasing barriers to start treatment. However, what is less clear is when to stop treatment. What indicators suggest stable recovery? Recovery process The DSM-5 definition of remission from SUD is ba

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

Does Low to Moderate Alcohol Drinking Help or Hurt Cognition?

Topics: Alcohol | Alcohol Use | Alcohol use disorder | Cognition | Cognitive Decline | Comorbidity

Review of: Zhang R et al, JAMA Netw Open 2020;3(6):e207922 Is alcohol good or bad for cognition? The evidence is mixed. A new study brings additional clarity to this question by including a diverse patient population and by using longitudinal cognitive measurements of the subjects as opposed to cross-sectional evaluations at one time point. In an

Despair, Loneliness, and Substance Use Disorders

Topics: Alcohol | Alcohol use disorder | Opioid Use Disorder | Opioids | Relationships | Special populations | treatment

Despair and loneliness are underappreciated contributors to substance use disorders (SUD). Their impact can be seen particularly in rural areas hit hard by industrial restructuring and poverty. This article will explore the interplay between despair, loneliness, and SUD and will review some strategies to use in your patients. Hardship From 1999 to 2

Faith and Addiction

Topics: Alcohol | Alcohol use disorder | Connections | Opioid Use Disorder | Opioids | treatment

Discussing a patient’s spiritual life might not be something you do routinely. Conversations can be time-consuming, uncomfortable, or seemingly irrelevant to treating a substance use disorder (SUD). But studies have shown that faith can be an asset in addiction treatment. Patients may want to discuss their spiritual lives with you or have questions ab

Is AA the Toast of the Town?

Topics: Alcohol | Alcohol use disorder | Behavioral treatment | Meta-analysis | Systematic review

Review of: Kelly JF et al, Cochrane Database Syst Rev 2020;(3):CD010216 Alcoholics Anonymous (AA) is the most widely used psychosocial treatment for alcohol use disorder (AUD). Historically, low quality of scientific evidence has limited our ability to speak confidently of AA’s effectiveness. Previous Cochrane reviews (which tend to occupy the high

A Timely Look at Community Reinforcement for Seniors With Unhealthy Alcohol Use

Topics: Alcohol | Alcohol use disorder | Geriatric Psychiatry | Motivational Interviewing | Psychotherapy

Review of: Andersen K et al, Addiction 2020;115(1):69–81 During the COVID-19 pandemic, when every personal contact requires risk-reward deliberations, understanding the impact of relationships on health is crucial. This timely study, conducted from 2014 through 2016, investigated whether social networks reduce drinking among older adults with alcoh

Efficacy and Acceptability of Varenicline for Alcohol Use Disorder

Topics: Alcohol | Alcohol use disorder | Pharmacology | Tobacco use disorder | Varenicline

REVIEW OF: Oon-Arom A et al, Drug Alcohol Depend 2019;205:1–9 Varenicline, a partial agonist of one of the nicotinic receptors, is approved for the treatment of tobacco use disorder and has also been found to decrease alcohol use in some individuals who smoke. Naltrexone, acamprosate, and disulfiram are FDA approved and effective for alcohol use di