Management Of Substance Abuse Research Articles

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.

Vitamin D Deficiency Is Associated With Silent Coronary Artery Disease in Cardiovascularly Asymptomatic African Americans With HIV Infection

Growing evidence suggests that vitamin D deficiency Is associated with clinical coronary artery disease (CAD). The relationship between vitamin D deficiency and subclinical CAD in HIV-infected individuals is not well-characterized. Computed tomographic (CT) coronary angiography was performed using contrast-enhanced 64-slice multidetector CT imaging, and vitamin D levels and the presence of traditional and novel risk factor for CAD were obtained in 674 HIV-infected African American (AA) participants aged 25-54 years in Baltimore, MD, without symptoms/clinical evidence of CAD. The prevalence of vitamin D deficiency (25-hydroxy vitamin D <10 ng/mL) was 20.0% (95% confidence interval [CI], 16.9-23.1). Significant (≥50%) coronary stenosis was present in 64 (9.5%) of 674 participants. Multiple logistic regression analysis revealed that male gender (adjusted odds ratio [OR], 2.19; 95% CI, 1.17-4.10), diastolic BP ≥85 mmHg (adjusted OR: 1.94, 95% CI: 1.02 -3.68), low-density lipoprotein cholesterol ≥100 mg/dL (adjusted OR, 1.95; 95% CI, 1.13-3.36), cocaine use for ≥15 years (adjusted OR, 1.77; 95% CI, 1.01-3.10), use of antiretroviral therapies for ≥6 months (adjusted OR, 2.26; 95% CI, 1.17-4.36), year of enrollment after 2005 (adjusted ORs for 2006-2007, 2008-2009, and 2010 were 0.32 [95% CI, 0.13-0.76], 0.26 [95% CI, 0.12-0.56], and 0.32 (95% CI, 0.15-0.65], respectively), and vitamin D deficiency (adjusted OR, 2.28; 95% CI, 1.23-4.21) were independently associated with significant coronary stenosis. Both vitamin D deficiency and silent CAD are prevalent in HIV-infected AAs. In addition to management of traditional CAD risk factors and substance abuse, vitamin D deficiency should be evaluated in HIV-infected AAs. These data support the conduct of a prospective trial of vitamin D in this high-risk patient population.

Can nurses stem the rising tide of alcohol abuse?

British Journal of NursingVol. 21, No. 5 Healthcare PolicyCan nurses stem the rising tide of alcohol abuse?Alan GlasperAlan GlasperSearch for more papers by this authorAlan GlasperPublished Online:16 Aug 2013https://doi.org/10.12968/bjon.2012.21.5.312AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References BBC (2012) David Cameron vows to tackle binge drinking ‘scandal’. Change4Life (2012) Change4Life website. Is drink sneaking up on you? http://tinyurl.com/85jhxsv (accessed 29 February 2012) Google ScholarCenters for Disease Control and Prevention (2011) Alcohol and Public Health: Fact Sheets. http://tinyurl.com/6nhtehz (accessed 29 February 2012) Google ScholarChange4Life (2012a) Home page. Is drink sneaking up on you? http://tinyurl.com/85jhxsv (accessed 29 February 2012) Google ScholarChange4Life (2012b) Cutting down on alcohol with the Drinks Checker. http://tinyurl.com/7hhmf9l_ (accessed 29 February 2012) Google ScholarDepartment of Health (2012a) Change4Life launches its first alcohol campaign. http://tinyurl.com/8aylhxj (accessed 29 February 2012) Google ScholarDepartment of Health (2012b) Change4Life. http://tinyurl.com/8yhyyeo (accessed 29 February 2012) Google ScholarDar K (2006) Alcohol use disorders in elderly people: fact or fiction. Advances in Psychiatric Treatment 12(6): 173–81 Crossref, Google ScholarLock CA, Kaner E, Lamont S, Bond S (2002) A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care. J Adv Nurs 39(4): 333–42 Crossref, Medline, Google ScholarParliament (2009) Alcohol - Health Committee: 6. Education and information policies. http://tinyurl.com/7uxldz9 (accessed 29 February 2012) Google ScholarStandridge JB, Zylstra RG, Adams SM (2004) Alcohol Consumption: An Overview of Benefits and Risks. Southern Medical Journal 97(7): 664–72 Crossref, Medline, Google ScholarThe Food & Drink Innovation Network (2012) Supermarkets launch new in-store alcohol unit labelling. http://tinyurl.com/82ka8jv (accessed 29 February 2012) Google ScholarWorld Health Organization (2012a) Is harmful use of alcohol a public health problem?. http://tinyurl.com/6m82hhq (accessed 29 February 2012) Google ScholarWorld Health Organization (2012b) Management of substance abuse: Dependence syndrome. http://tinyurl.com/874hst5 (accessed 29 February 2012) Google ScholarYouGov (2009) YouGov/Know Your Limits Survey Results. http://tinyurl.com/76fv8q5 (accessed 29 February 2012) Google Scholar FiguresReferencesRelatedDetailsCited byIncreased Detection of Alcohol Consumption and At-risk Drinking with Computerized Alcohol ScreeningThe Journal of Emergency Medicine, Vol. 44, No. 4 6 March 2012Volume 21Issue 5ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 16 August 2013 Published in print 6 March 2012 Information© MA Healthcare LimitedPDF download

Preliminary Efforts Directed Toward the Detection of Craving of Illicit Substances: The iHeal Project

Many behavioral interventions, whether for the management of chronic pain, overeating, medication adherence, or substance abuse, are ineffective outside of the clinic or office environments in which they are taught. This lack of utility has spawned interest in enabling technologies that are capable of detecting changes in affective state that potentially herald a transition to risky behaviors. We have therefore undertaken the preliminary development of "iHeal", an innovative constellation of technologies that incorporates artificial intelligence, continuous biophysical monitoring, wireless connectivity, and smartphone computation. In its fully realized form, iHeal can detect developing drug cravings; as a multimedia device, it can also intervene as the cravings develop to prevent drug use. This manuscript describes preliminary data related to the iHeal Project and our experience with its use.

Anesthesia and Addiction, International Anesthesiology Clinics 49 (1), Winter 2011

Sanford Bemidji Medical Center, Bemidji, Minnesota. rowe77@earthlink.netBy Ethan O. Bryson, M.D., and Elizabeth A. M. Frost, M.D. Philadelphia, Lippincott Williams &amp; Wilkins, 2011. Pages: 176. Price: $176.00.The successful treatment of substance abuse has been challenging addiction medicine specialists for years, while the spectrum of illicit drugs has been increasing. The prevalence of alcoholism or drug addiction is vast, so that most people personally know someone with the disease or have experienced it themselves. Alcoholics and drug addicts commonly present to surgery, sometimes acutely intoxicated, posing a particular challenge to anesthesia clinicians. In addition, anesthesiologists and nurse anesthetists are themselves at risk for becoming addicted to the same medications they administer to patients; a wide path of personal destruction or death can occur unless a recovery program is offered in time.Anesthesia and Addiction enhances and clarifies current knowledge in this rapidly changing field. The book begins with a chapter on the genetic and cellular mechanisms of addiction, effectively leading to the next chapter on management of substance abuse in the hospital setting. The integration of the scientific basis of addiction and its clinical management is a strength of the presentation throughout the book.From chapters on anesthetic implications of alcoholism and illicit opioid abuse to chapters on cocaine and the club drugs as well as marijuana and other inhaled toxins, the book covers a wide range of abused substances. Eye-opening statistics are given for each drug of abuse. Pathophysiology and organ dysfunction are detailed, laying the foundation for anesthetic considerations.Other chapters address specialized topics such as anesthesia for opioid detoxification and drug and alcohol use during pregnancy. Drug abuse in the patient with chronic pain and perioperative implications of buprenorphine maintenance treatment are additional chapter topics. Controversial areas of management are presented thoughtfully and handled fairly. Finally, “The Drug-Seeking Anesthesia Care Provider” chapter sheds new light on the scope of this underestimated problem, which may have an undetected incidence of diversion reaching 8–9%, according to survey data presented in the book. My opinion is that typical signs and symptoms may be inadequate to identify many addicts. Perhaps the focus should be shifted to consulting recovering addicts, who may be willing to identify methods used to divert the drug along with associated in-hospital behaviors.Anesthesia and Addiction is concise and informative, clearly dividing the material into labeled categories. The book strikes the right balance between being comprehensive yet succinct. Each chapter is supported by helpful tables and an extensive list of references.As a pioneer textbook of its kind, Anesthesia and Addiction sets a high standard for future endeavors. It is relevant reading for all anesthesia clinicians, whether experienced or intraining. The topics covered are undoubtedly encountered in clinical practice.Furthermore, institutions could also use the material to formulate diversion prevention programs, a safety initiative to protect our own.

Is it time to consider comorbid substance abuse as a new indication for antipsychotic drug development?

Comorbid drug abuse in schizophrenia has been consistently reported as high, with estimates ranging between 10-70%. Comorbid addictive states in schizophrenia are possibly multifactorial, yet recent research assigns a significant neurobiological role in its genesis. Abnormalities in hippocampal/cortical function in schizophrenia which mediate reward and reinforcement behavior are identified as central to the development and maintenance of comorbid addictive states. Preliminary data suggest that the vulnerability of patients with schizophrenia to substance use disorders may be a primary disease symptom. The management of comorbid substance abuse in schizophrenia relies on the use of antipsychotic medications. Recent data raise the concern about whether first-generation antipsychotics in long-term use can conversely lead to enhancement of the abused substance's reinforcing properties. Some recent reports have assigned a favorable outcome to clozapine and second-generation antipsychotics, pointing to a possible differential role for various antipsychotics. In view of the high prevalence of comorbid drug abuse in schizophrenia, its impact on outcome of treatment and the recent emerging neurobiological information, it is my contention that comorbid drug abuse constitutes a dimension by itself and deserves to receive an indication in the development of new antipsychotics similar to negative symptoms or cognitive deficits.

Management of Substance Abuse in the Hospital Setting

Management of Substance Abuse in the Hospital Setting

Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a Public Health Approach to the Management of Substance Abuse

Summary.Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive and integrated approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders and those at risk. This paper describes research on the components of SBIRT conducted during the past 25 years, including the development of screening tests, clinical trials of brief interventions and implementation research. Beginning in the 1980s, concerted efforts were made in the US and at the World Health Organization to provide an evidence base for alcohol screening and brief intervention in primary health care settings. With the development of reliable and accurate screening tests for alcohol, more than a hundred clinical trials were conducted to evaluate the efficacy and cost effectiveness of alcohol screening and brief intervention in primary care, emergency departments and trauma centers. With the accumulation of positive evidence, implementation researc...

Family Together: Developing a Family Educational Program against Drug Abuse in Taipei County

Adolescent drug abuse has become a serious problem in Taiwan. Therefore, the main purpose of this research was to develop a program for the high-risk adolescents and their parents to prevent adolescent substance abuse in Taipei County, Taiwan. The program named ”Family Together” focused on emotional management, communication, and adolescent substance abuse prevention. The features of the research include Family-based program, Evaluation, Alliance, Science-based, and Training (FEAST). Fifty high-risk students and thirty-four parents from three junior high schools in Taipei County participated in the program. The program includes six steps which are draw-up, coordination, training, implementation, evaluation, and dissemination. The Family Together program had been found to be effective. The program could improve the attitudes toward and knowledge of communication and the knowledge and skills regarding prevention of adolescent substance abuse among the parents. In addition, the program could improve the knowledge of and attitudes toward emotional management and communication, knowledge of substance abuse, and willingness to use refusal skills among the adolescents. The future efforts might focus on strengthening seed-teacher training program and involving general community adolescents and their parents to participate the program. Furthermore, suggestions for government to promote family-based program are also provided.

Logotherapeutic Management Of Persons With Substance Abuse/Dependence

The paper examines the logotherapeutic management of persons with substance abuse/dependence which involves the utilization of a multi- displinary approach. Therefore, the paper highlights how this view is in relationship with the concept of logotherapy about man that comprises biological, psychological and spiritual dimensions which the management of substance abuse has to be based upon. Thus, efforts are made to describe logotherapy and logotherapeutic view of substance abuse/dependence.It is concluded with arguments on the need to include logotherapeutic approach to the management of persons with substance abuse /dependence.

Addressing substance abuse among nursing students: development of a prototype alternative-to-dismissal policy.

Substance abuse and dependency are health issues that require effective policies within nursing education. In 2007, the University of Memphis School of Nursing drafted a new substance abuse policy using the American Association of Colleges of Nursing's Policy and Guidelines for Prevention and Management of Substance Abuse in the Nursing Education Community. These guidelines include the assumption that addiction is an illness that can be treated and the philosophy that schools of nursing are committed to assisting students with recovery. The new policy at University of Memphis School of Nursing incorporated prevention, education, identification, evaluation, treatment referral, and reentry guidelines, as well as disciplinary action for students unwilling to undergo rehabilitation. It is hoped this new substance abuse policy will serve as a prototype for other institutions.

Cocaine effects during d-amphetamine maintenance: A human laboratory analysis of safety, tolerability and efficacy

Agonist replacement therapies are effective for managing substance abuse disorders including nicotine and opioid dependence. The results of preclinical laboratory studies and clinical trials indicate that agonist replacements like d-amphetamine may be a viable option for managing cocaine dependence. This experiment determined the physiological and behavioral effects of cocaine during d-amphetamine maintenance in seven cocaine-dependent participants. We predicted cocaine would be well tolerated during d-amphetamine maintenance. We also predicted d-amphetamine would attenuate the behavioral effects of cocaine. After 3–5 days of d-amphetamine maintenance (0, 15, and 30mg/day), volunteers were administered ascending doses of cocaine (4, 30, 60mg, IN) within a single session. Cocaine doses were separated by 90min. Cocaine produced prototypical physiological (e.g., increased heart rate, blood pressure, and body temperature) and subject-rated (e.g., increased ratings of Good Effects) effects. During maintenance on the highest d-amphetamine dose, the heart rate increasing effects of cocaine were larger than observed during placebo maintenance. These effects were not clinically significant and no unexpected or serious adverse events were observed. d-Amphetamine attenuated some of the subject-rated effects of cocaine. These results are concordant with those of previous preclinical studies, human laboratory experiments and clinical trials, further suggesting that agonist replacement therapy may be a viable strategy for managing cocaine abuse. Additional research in humans is needed to determine whether d-amphetamine attenuates the effects of cocaine under different experimental conditions (e.g., higher cocaine doses) and behavioral arrangements (e.g., drug self-administration or discrimination).

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Many persons with HIV do not receive needed behavioral health services. This study examined the impact of medical clinic characteristics on access to mental health and substance abuse care for persons with HIV. This was a longitudinal survey of patients and clinic directors participating in the HIV Cost and Services Utilization Study, a national probability sample of persons in care for HIV between 1996 and 1998 (N=2,031). Primary outcomes were receipt of outpatient mental health specialist care, outpatient substance abuse care, and abstinence from substance use in the past 30 days. After adjustment for patient characteristics, the likelihood of care by a mental health specialist was higher for patients in HIV specialty clinics (odds ratio [OR]=2.1, 95% confidence interval [CI]=1.2-3.5) and clinics with a combination of on-site case management and affiliated mental health care (OR=2.3, CI 1.3-4.4, for off-site affiliated care; OR=2.1, CI=1.2-3.7, for on-site care). Outpatient substance abuse care also was more likely for patients in clinics with on-site case management and affiliated substance abuse care (OR=4.3, CI=1.5-12.2, for off-site affiliated care; OR=3.2, CI=1.3-8.0, for on-site care). In a subgroup of persons reporting active substance use, care in clinics with on-site case management predicted 30-day abstinence from substances at follow-up (OR=1.7, CI=1.1-2.5). The organizational structure of medical clinics can have an important effect on use of mental health and substance abuse specialist care.

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

Public Health Behind Bars

Public Health Behind Bars

Cliniciansʼ evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit*

The purpose of this study was to describe clinicians' evaluation and management of co-existing mental health, substance abuse (MHSA), and chronic pain (CP) conditions in patients with prolonged critical illness. Little is known about the evaluation and management of these conditions in the intensive care unit, and practice guidelines do not address management in the context of critical illness, optimal sedation/analgesia, or ventilator weaning. Longitudinal qualitative description. Intensive care unit of an urban academic medical center. Total of 12 patients with co-existing MHSA or CP conditions who were weaning from mechanical ventilation. Intensive care unit clinicians, patients, and family members were formally interviewed and directly observed in the critical care setting for 56 consecutive weeks. Transcribed interviews, field notes, and clinical records, representing >400 documents, were reviewed and coded using constant comparative analysis to identify the facilitators, barriers, contextual factors, and consequences associated with the evaluation and management of MHSA and CP conditions. Numeric clinical data supplemented and clarified thematic findings. Facilitators of MHSA and CP evaluation and management included family as history keepers, the use of subspecialty consultations, and anticipated alcohol withdrawal. Barriers included limited history taking and assessment of MHSA and CP conditions and the use of cognitive shortcuts. Consequences included nonintegration of MHSA and CP medications and diagnoses, episodic pharmacologic responses to psychobehavioral symptoms, and clinician-patient interpersonal tension. Contextual factors involved ambiguous psychobehavioral symptomatology, patients' critical illness and inability to speak, and competing clinical goals. The explicit evaluation and management of MHSA and CP conditions was highly variable and inconsistent across cases. Findings suggest that MHSA and CP conditions require monitoring and management similar to that required for other chronic conditions. Multidisciplinary, individual-level, and system-level responses are warranted to address the complex interplay of barriers, consequences, and context.

Contingency management is efficacious for cocaine abusers with prior treatment attempts.

Efforts are underway to detect subgroups who may be more or less responsive to contingency management (CM) substance abuse treatments. This study examined the impact of prior treatment attempts on primary and posttreatment outcomes in a combined sample of cocaine abusers randomized to standard care substance abuse outpatient treatment (SC) or SC plus CM. Participants (N = 393) were categorized according to self-reported prior treatment attempts (0-1, >or=2). Participants with multiple prior treatment attempts were older, had more severe alcohol and cocaine use disorders, and had greater employment-related problems. Participants with 0?1 prior treatment attempts had comparable treatment retention, regardless of treatment condition; however, among participants with multiple prior treatment attempts, retention was greater for CM than SC. A similar, but nonsignificant (p = .08) pattern was evident for longest duration of abstinence (LDA). LDA was a significant predictor of negative (for cocaine, alcohol, and opiates) specimen results at Month 9. The results provide support for CM as an advantageous option for individuals with multiple prior treatment attempts, as well as for substance abuse treatment patients in general.

Substance Abuse Counseling

1. Dominic Hollman, MD 2. Elizabeth Alderman, MD 1. Children's Hospital at Montefiore Bronx, NY Adolescent Substance Use Disorders and Comorbidity. Simkin DS. Pediatr Clin North Am. 2002;49 :463– 477[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders. 2nd ed. Mee-Lee D. Chevy Chase, Md: The American Society of Addiction Medicine, Inc;2001 Indications for Management and Referral of Patients Involved in Substance Abuse. American Academy of Pediatrics Committee on Substance Abuse. Pediatrics. 2000;106 :143– 148[OpenUrl][5][Abstract/FREE Full Text][6] Monitoring the Future National Survey Results on Drug Use, 1975–2005, Volume I: Secondary School Students. (NIH Publication No. 06–5883). Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Bethesda, Md: National Institute on Drug Abuse;2006Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse. Kulig JW and the American Academy of Pediatrics Committee on Substance Abuse. Pediatrics. 2005;115 :816– 821[OpenUrl][7][Abstract/FREE Full Text][8] Substance use among adolescents presents a difficult challenge to the pediatrician. Use of illicit drugs, as well as substances such as tobacco and alcohol, is common among the adolescent population and should be ascertained and addressed by pediatricians at the routine health supervision visit. Many pediatricians are uncomfortable with this aspect of patient care. All primary care physicians who take care of adolescents should be familiar with the signs of substance use and abuse, have the expertise to perform office-based intervention, recognize situations that require referral for outside treatment, and be able to guide the patient and family toward appropriate treatment settings. Use of illegal drugs among high-school students has been relatively stable over the past several years, down from peak use in the late 1990s. In the 2005 Monitoring the Future Study of middle school and high school students in the United States, 50% of 12th graders reported lifetime use of any illicit substance, similar … [1]: {openurl}?query=rft.jtitle%253DPediatric%2Bclinics%2Bof%2BNorth%2BAmerica%26rft.stitle%253DPediatr%2BClin%2BNorth%2BAm%26rft.aulast%253DSimkin%26rft.auinit1%253DD.%2BR.%26rft.volume%253D49%26rft.issue%253D2%26rft.spage%253D463%26rft.epage%253D477%26rft.atitle%253DAdolescent%2Bsubstance%2Buse%2Bdisorders%2Band%2Bcomorbidity.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0031-3955%252801%252900014-1%26rft_id%253Dinfo%253Apmid%252F11993293%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0031-3955(01)00014-1&link_type=DOI [3]: /lookup/external-ref?access_num=11993293&link_type=MED&atom=%2Fpedsinreview%2F28%2F9%2F355.atom [4]: /lookup/external-ref?access_num=000175194700014&link_type=ISI [5]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DCommittee%2Bon%2BSubstance%2BAbuse%26rft.auinit1%253D%2B%26rft.volume%253D106%26rft.issue%253D1%26rft.spage%253D143%26rft.epage%253D148%26rft.atitle%253DIndications%2Bfor%2BManagement%2Band%2BReferral%2Bof%2BPatients%2BInvolved%2Bin%2BSubstance%2BAbuse%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.106.1.143%26rft_id%253Dinfo%253Apmid%252F10878166%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=106/1/143&atom=%2Fpedsinreview%2F28%2F9%2F355.atom [7]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DKulig%26rft.auinit1%253DJ.%2BW.%26rft.volume%253D115%26rft.issue%253D3%26rft.spage%253D816%26rft.epage%253D821%26rft.atitle%253DTobacco%252C%2BAlcohol%252C%2Band%2BOther%2BDrugs%253A%2BThe%2BRole%2Bof%2Bthe%2BPediatrician%2Bin%2BPrevention%252C%2BIdentification%252C%2Band%2BManagement%2Bof%2BSubstance%2BAbuse%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2004-2841%26rft_id%253Dinfo%253Apmid%252F15741395%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=115/3/816&atom=%2Fpedsinreview%2F28%2F9%2F355.atom

ASIA PACIFIC COLUMN: New challenges and opportunities in managing substance abuse in Malaysia

Until recently, Malaysia has lagged behind in the treatment of drug addiction and related disorders, despite experiencing severe drug problems. By the end of 2004, 234,000 heroin users or heroin-dependent individuals had been registered in the official government registry, but other estimates exceed 500,000 for heroin abusers in the country. Amphetamine-type stimulant abuse is also increasing and of considerable public and government concern. Among the population of drug users, HIV and other infectious diseases rates are very high. In the Western Pacific regions, Malaysia has the second highest HIV prevalence (after Vietnam) among adult populations (0.62%) and the highest proportion of HIV cases resulting from injection drug use (76.3%). Drug use and related disorders exert a heavy burden on the country's health care and legal systems. Historically, drug abusers were rehabilitated involuntarily in correctional, rather than health-care, facilities. This primarily criminal treatment approach had limited effectiveness which led to widespread public dissatisfaction and the recent introduction of medical treatments for addiction. Naltrexone was introduced in 1999; buprenorphine was introduced in 2001 and methadone in 2003. Agonist maintenance programmes were embraced rapidly by the medical community in Malaysia. Currently, over 30,000 opiate-dependent patients are treated with agonist maintenance treatments by more than 500 medical practitioners in Malaysia. Despite these recent advances, treatments for amphetamine-type stimulant abuse or dependence are underdeveloped, and diversion of agonist medications is an emerging concern.

Management of Comorbid Bipolar Disorder and Substance Abuse

Rates of alcohol and other substance abuse or dependence disorders are substantially higher in persons with bipolar disorders than in the general population, reaching approximately 61% in patients with bipolar I disorder. As a result, clinicians must be prepared to treat substance use disorders and bipolar disorder simultaneously. This presentation reviews data from the 4 published randomized, controlled trials of pharmacotherapy (lithium, carbamazepine, valproate, and quetiapine) in this population. Also reviewed are data from promising open-label, uncontrolled trials. While the results of published research have been generally positive and support the efficacy and tolerability of several agents from different classes in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence, more randomized, controlled research is needed.