Teen Drinking: Risks and Responses

Topics: adolescents | Alcohol | Alcohol Poisoning | Risk of Addiction | Sexual Abuse | Substance Use Disorder

CCPR: Welcome, Dr. Yule. How prevalent is teen drinking? Dr. Yule: While there has been a decline in alcohol use since the 1980s, alcohol remains the substance most widely used by adolescents. When we look at past-month use by 12th graders in 2019, 5.7% had smoked cigarettes, 22.3% had used cannabis, and 29.3% had used alcohol (www.niaaa.nih.gov/public

Combination Treatment for Schizophrenia

Topics: Adjunct treatment | Antidepressant | Antipsychotic | Benzodiazepine | CATIE | Combination treatment | Free Articles | Mood stabilizer | Outcomes | Psychopharmacology | Schizoaffective disorder | Schizophrenia | Substance Use Disorder

CHPR: You recently published a study on the use of adjunctive medications in patients with schizophrenia (Stroup TS et al, JAMA Psychiatry 2019;76(5):508–515). Your findings were provocative as you found that adjunctive medications often help improve patients’ outcomes, yet many clinicians avoid polypharmacy because of concern that patients will exp

Outpatient Management of Opioid Addiction

Topics: Cannabis | Depression | Existing marijuana | Potency | Substance Use Disorder | Weed | Withdrawal

CCPR: Tell us about your position and what you do. Dr. Gomez-Luna: I directed a short-term adolescent residential program, where I saw a need for identifying and treating kids’ co-occurring conditions. I did another fellowship in addiction psychiatry, then joined studies at Yale on tobacco use and electronic nicotine devices in adolescents. Now I’m

Assessing and Treating Cannabis Use Disorder

Topics: Cannabis | Depression | Marijuana | Potency | Substance Use Disorder | Weed | Withdrawal

CCPR: Tell us a little bit about your background. Dr. Gobbi: I trained in medicine, psychiatry, and psychotherapy in Rome, Italy, then received a PhD in neuroscience, working in preclinical psychopharmacology. I now work in our mood disorder clinic and ER, and I direct our basic psychopharmacology lab (neurobiological psychiatry unit), including resear

Managing Substance-Related Agitation

Topics: Agitation | Substance Use Disorder | Withdrawal

In emergency departments, psychiatrists are often consulted on patients presenting with agitation. In many cases, these patients are under the influence of substances—either from intoxication or withdrawal. It is important to recognize when a patient is under these effects, as acute management of the agitation will vary drastically depending on which

Treating Co-Occurring Psychiatric Disorders

Topics: Co-occurring disorders | Diagnosis | Substance Use Disorder

CATR: Why do you think clinicians should pay attention to psychiatric disorders co-occurring with addiction? Dr. Ross: The reason is that they’re very common. For example, about 80% of people with schizophrenia have nicotine use disorder, and 50% have a non-nicotine substance use disorder (SUD) (Miller SC, Fiellin DA, Rosenthal RN, Saitz R, eds. ASAM

Cognitive Behavioral Therapy for Substance Use Disorders

Topics: Cognitive Behavioral Therapy | Free Articles | Substance Use Disorder

Cognitive behavioral therapy (CBT) is one of the most widely used psychotherapies. It was developed in the 1960s by Aaron Beck specifically for the treatment of depression, but its core principles were quickly adapted and applied to a variety of diagnoses. We now have evidence-based CBT interventions not only for depression but also for anxiety, PTSD, b

Co-Occurring Addiction and PTSD

Topics: Addiction Treatment | Co-occurring disorders | PTSD | Substance Use Disorder | Trauma

CATR: We know PTSD often co-occurs with addiction. What should clinicians pay attention to? Dr. Vojvoda: Individuals who have PTSD have a high risk of developing other disorders, including substance use disorders (SUDs). Studies have shown that both in the veteran and non-veteran populations, these numbers are high. For example, one study of the genera

How Does Adding CBT Help People With SUD?

Topics: Substance Use Disorder

Review of: Ray LA et al, JAMA Netw Open 2020;3(6):e208279 When we see patients with addiction for medication management appointments, we often recommend psychotherapy. How helpful is adding a particular psychotherapy like cognitive behavioral therapy (CBT) to medications for substance use disorder (SUD)? The authors reviewed 30 randomized controll

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