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

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

Helping People With Co-Occurring Mental Health and Substance Use Disorders

Topics: Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes

When Dual Diagnosis Patients Request Addictive Medications: What to Do?

Topics: Practice Tools and Tips | Substance Abuse

CATR: A common dual diagnosis scenario is that we are treating a patient for depression or anxiety, the patient is on an SSRI and a benzodiazepine, and then suddenly we find out the patient is also on methadone maintenance or has been using medical marijuana regularly. Then we have to decide what to do. For example, should we continue to prescribe the b

Take The CME Post-Test for Dual Diagnosis, CATR, August 2017

Topics: Practice Tools and Tips | Psychopharmacology Tips | Research Updates | 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 1 CME credit. 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 logged

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

Take The CME Post-Test for Alternatives to 12-Step Programs, CATR, June/July 2017

Topics: Addiction | Psychotherapy | 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

Can a One-Week Naltrexone Detox Reduce Outpatient Opioid Relapse Rates?

Topics: Addiction | Psychopharmacology | Research Update | Substance Abuse

Review of: Sullivan M et al, Am J Psychiatry 2017; Epub ahead of print. Study Type: Randomized, open-label, parallel-groups trial Naltrexone is an opioid blocker that is FDA-approved for the treatment of alcoholism. However, it is also effective off-label for treating opioid use disorder. The medication comes in two forms: an oral pill (brand name

Cannabis in 2017: Preparations and Modes of Delivery

Topics: Addiction | Child Psychiatry | Substance Abuse

While the age-old tradition of smoking cannabis remains very common, several other options for preparing the drug are becoming widely available and frequently used. In this article, we’ll update you on the modern preparations and routes of administration. The main psychoactive component of cannabis is ∆9-tetrahydrocannabinol (THC), which is pres

Adolescent Marijuana Use and Clinical Practice

Topics: Child Psychiatry | Substance Abuse

CCPR: Clinicians working with adolescents have seen that kids are frequently using marijuana now—and stronger strains of it. What does this exposure mean for them? Is there any suggestion that marijuana use is affecting development? Dr. Cermak: There is conclusive evidence that marijuana use, particularly in early adolescence, can affect brain deve

The Neuroscience of Marijuana

Topics: Child Psychiatry | Neuroscience in Psychiatry | Substance Abuse

The neuroscience of cannabis has advanced at a remarkable pace. While it’s a complicated story, the basic effects of marijuana on our brains are pretty well established and fairly easy to grasp. Some knowledge of these effects can be clinically useful, particularly when it comes to predicting the potential effects of excessive THC that your patients m