Stimulant Abuse

Topics: ADHD | Substance Abuse

David Sorenson, M.D., is medical director of the Anna Jaques Hospital Child Psychiatry Inpatient Unit in Amesbury, Massachusetts. His experiences with patients misusing ADHD medications should give us pause. “Many psychiatrists are naive about stimulants. I’ve heard a lot of stories about what kids are actually doing with their medications by lis

Insomnia and Substance Use Disorders

Topics: Sleep Disorders | Substance Abuse

TCPR: Why is sleep so important in addictions? Dr. Rosenlicht: Sleep problems are common in recovery, and they have many causes such as withdrawal states, circadian rhythm disruptions, and a host of psychiatric and medical comorbidities. It’s a two-way street: Insomnia raises the risk of substance misuse, and addiction can cause or worsen sleep probl

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

Narcotics Anonymous: What to Tell Your Patients

Topics: Practice Tools and Tips | Substance Abuse

Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use (see the November/December 2015 CATR for more info on AA). But what about Narcotics Anonymous (NA)? Is it just an opioid-focused version of AA? In this article, we�

Using Medical Management in Treating Opioid Use Disorder

Topics: Practice Tools and Tips | Substance Abuse

CATR: We often hear about an intervention called medical management (MM) for treating addiction. Could you tell us what MM is? Dr. Saxon: To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that

Opioid Treatment Options

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

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing. And the trajectory in this country is worsening—in 2016, we aver

Is Cannabis Bad for Cognition?

Topics: Free Articles | Research Update | Substance Abuse

Review of: Cobb SJ et al, JAMA Psychiatry 2018;75(6):585–595 Our patients typically tell us that, according to the internet, weed is perfectly safe and does not affect their ability to think or function. Thirty states and the District of Columbia have laws legalizing cannabis, supporting the notion that people have begun to think of marijuana as re

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

Effects of Cannabis Use on Smoking Cessation

Topics: Research Update | Smoking Cessation | Substance Abuse

REVIEW OF: Weinberger AH et al, J Clin Psychiatry 2018;79(2):17m11522 When counseling your patients to quit smoking, you may also want to consider asking them about their past marijuana use. Results from a recent study suggest that there may be a correlation between cannabis and tobacco smoking. Analysis of longitudinal data of almost 35,000 adult

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

Can Computerized Interventions Reduce Cannabis Use?

Topics: Research Update | Substance Abuse

REVIEW OF: Olmos A et al, Addict Behav 2018;79:52–60 As medical and recreational marijuana become legalized in more states, more emphasis is being placed on treatment of those with cannabis use disorders. But with our clinics already at capacity, how can we find the most efficient way of providing therapy? Computerized interventions are already ava

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

CME Post-Test - Street Drugs, CATR, March/April 2017

Topics: Addiction | Practice Tools and Tips | Psychopharmacology | 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 log