Treatment Of Addictive Disorders Research Articles

Attitudes Toward Evidence-Based Pharmacological Treatments Among Community-Based Addiction Treatment Programs Targeting Vulnerable Patient Groups

ABSTRACT A national sample of addiction treatment Program Directors (N = 296) were assessed regarding their attitudes about pharmacological treatment for addiction disorders. Multivariable analyses indicate that directors who worked in organizations affiliated with research institutions and who had more professional experience had significantly more positive attitudes about a range of pharmacological therapies. Also, directors in organizations serving higher percentage homeless clients and clients with severe and persistent mental illness had more negative attitudes toward use of buprenorphine. Community-based organizations providing addiction treatment to specific vulnerable client groups exhibit more negative attitudes about pharmacological evidence-based practices and may underutilize those practices.

Book Review: Principles of addiction medicine, 4th edition

Scott Schappacher reviews the 4th edition of Principles of Addiction Medicine, a text from the American Society of Addiction Medicine which covers the basic scientific principles to pharmacology of addictive substances.CPNP members maintain a suggested reading list to provide information on peer recommended resources and convenient access to the highest quality neuropsychopharmacology publications. A reminder that if you shop with CPNP, by following the links below to Amazon, a small commission will be paid to CPNP which helps to financially support our mission to improve the minds and lives of individuals with psychiatric and/or neurologic disorders.You can help grow this list of resources by suggesting a bookBook: Principles of Addiction Medicine 4th EditionPublished in April of 2009 many of its contributors are affiliated with leading government agencies that study addiction and its science such as the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. The book is divided into fourteen sections and 106 chapters. Section one discusses the basic science and core concepts of drug addiction. Section two focuses on the pharmacology of abused substances. Section three covers diagnosis, assessment and early intervention. Section four gives the overview of addiction treatment. Section five covers special issues in addiction medicine, e.g. non-medical use of prescription medications. Section six covers management of intoxication and withdrawal. Section seven discusses pharmacological interventions. The remaining sections cover behavioral interventions, recovery programs, medical disorders and complications of addiction, co-occurring addictions and psychiatric disorders.This text provides a comprehensive overview of the diagnosis and treatment of addictive disorders, as well as the management of co-occurring medical and psychiatric conditions. Section two provides great information for the pharmacist searching for in depth information related to the pharmacology of addictive substances. Each chapter in this section is broken down by drug class, pharmacokinetics, physiologic effects, effects on physical health/human performance, and effects with other drugs. Topics include alcohol, non-alcohol sedative hypnotics, opioids, cocaine, amphetamines, other psychostimulants, caffeine, nicotine/tobacco products, cannabinoids, inhalants, and anabolic androgenic steroids. One example of useful information in this text is caffeine content of common foods and medications listed in chart form. This may be helpful in patients with anxiety and panic disorders because acute doses of caffeine above 200mg are more likely to produce negative subjective effects such as increased anxiety, nervousness, and jitteriness. When counseling these types of patients, the pharmacist can easily provide caffeine content of products that they normally consume and let them know they may be more sensitive to the anxiogenic effects of the caffeine. Another example of the helpful information provided in this text includes comprehensive, understandable explanations of pharmacological interventions for cocaine, methamphetamine, and other stimulant addiction. It gives information on four pharmacological approaches to the treatment of cocaine addiction. When a pharmacist is faced with a question related to substance abuse, this is a great resource to consult.This respected text from the American Society of Addiction Medicine is valuable for all physicians and mental-health personnel who specialize in addiction medicine and who treat patients with addiction disorders. The chapters blend scientific principles underlying addiction with the practical essentials of clinical addiction medicine. Many of the contributors are affiliated with leading government agencies that study addiction and its science, such as the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. The book will appeal to a wide and interdisciplinary range of professionals, especially those with interest or duties relating to addiction-related disorders, and in particular physicians seeking certification status via either the American Board of Addiction Medicine or the American Board of Psychiatry and Neurology.

SAT2 * TREATMENT OF ALCOHOL ADDICTION: HOW TO USE SODIUM OXIBATE? (D&A) * SAT2.2 * NEUROBIOLOGY OF GHB IN RELATION TO ALCOHOL DEPENDENCE

SAT2 * TREATMENT OF ALCOHOL ADDICTION: HOW TO USE SODIUM OXIBATE? (D&A) * SAT2.2 * NEUROBIOLOGY OF GHB IN RELATION TO ALCOHOL DEPENDENCE

Reconsolidation of a Cocaine-Associated Stimulus Requires Amygdalar Protein Kinase A

Drug addiction is a chronic disorder associated with recurrent craving and relapse often precipitated by the presence of drug-associated stimuli. Pharmacological and behavioral treatments that disrupt drug-associated stimulus memories could be beneficial in the treatment of addictive disorders. Memory restabilization (or reconsolidation) following retrieval of drug-paired stimuli depends upon the amygdala. Here we assessed whether amygdalar PKA is required for the reconsolidation of an appetitive, cocaine-paired stimulus. Rats were trained to lever press for intravenous cocaine infusions paired with a light/tone conditioned stimulus. After 12 d of acquisition, rats either underwent lever extinction (8-12 d) followed by light/tone reactivation and subsequent cue-induced and cocaine-induced (15 mg/kg, i.p.) reinstatement testing or were subsequently tested to assess the ability of the light/tone stimulus to serve as a conditioned reinforcer in the acquisition of a new instrumental response (nose poking). Bilateral intra-amygdalar infusions of the PKA inhibitor Rp-cAMPS (18 microg per side) given immediately following light/tone stimulus reactivation decreased subsequent cue-induced reinstatement and responding with a conditioned reinforcer, while having no effect on cocaine-induced reinstatement. Intra-amygdalar infusions of Rp-cAMPS made 3 h following reactivation or immediately following no stimulus reactivation had no effect on subsequent cue-induced reinstatement. These data show that memory reconsolidation for a cocaine-paired stimulus is retrieval dependent and time limited and critically depends upon amygdalar PKA.

New advances in addiction medicine

The high prevalence rate of the drug and alcohol-related problems highlights the public health importance of this disorder. The abuses of legal and illegal drugs remain one of the major medical problems in the world today. The total number of drug users in the world is now estimated at about 200 million people, equivalent to about five percent of the global population age 15–64 (United Nations Office on Drugs and Crime. World Drug Report, 2006). Cannabis remains by far the most widely used drug, followed by amphetamine-type stimulants, opiate and cocaine users. Alcohol abuse and alcoholism affects nearly 10% of the general population both in the United States (McGinnis and Foege, 1993) and in Europe (Hupkens et al., 1993). Drug and alcohol abuse have many medical consequences. Health effects may range between cardiomyopathies, immune impairment, endocrine disorders, metabolic and nutritional disorders, liver and gastrointestinal diseases, cancer disease, neuropsychiatric complications to name a few, so all kinds of physicians could be involved in the management of these patients. Medical approaches continue to develop with new discoveries in pharmacology, molecular genetics, and immunology. Indeed, in the last three decades, our increased knowledge about the molecular, biological and behavioral aspects of addiction has enabled us to improve the management and survival of these patients. For example, the discovery of the neurobiological basis of addiction and of different neural pathways involved in drug and alcohol abuse led to identify new pharmacological approaches to treatment that can be paired with psychosocial treatments. Furthermore, there are new advances in pharmacogenetics that can bring forward to era of personalized medicine to the addictions field. New vistas in vaccine research also promise to improve both the prevention and treatment of addictive disorders. All this scientific progress was, and shall continue to be, possible due to the rapid expansion of research in the field. Frontiers in Addictive Disorders will be at the cutting-edge of publishing papers that will shape our understanding and the treatment of addictive diseases now and in the future. The scope of the journal is very broad and ranges from the laboratory bench to society.

For Young Women Like Nicole, We Can Do Better

Twenty-two-year-old Nicole, who had a heroin addiction, died of an accidental overdose. Her family tried to get her help as she battled her addiction, but they found that treatment for addiction disorders was hard to access. Nicole's story underscores the need to continue to probe the gaps in the addiction treatment system and to share what we learn in hopes of helping others avoid this kind of tragedy. Fundamental changes are needed in the configuration of services and service providers to make effective treatments sufficiently attractive, accessible, and affordable.

Diferencias de personalidad entre adictos a sustancias y población general. Estudio con el TCI-R de casos clínicos con controles emparejados

Objective: This article explores differences in personality traits between subjects with substance addiction in treatment and subjects from the general population matched in the variables sex, age and educational level. Material and method: Consecutive sampling was used to obtain a sample of participants undergoing treatment for addictive disorders at a public centre (CAD 4). A sample of the general population was obtained by means of the snowball technique. Only pairs (one participant from each sample) with the same age, sex and educational level were considered. In this way, 55 pairs were obtained. Cloninger's TCI-R was used and the global results were compared, crossing all variables. Results: Significant and consistent differences were found in just two traits: Novelty-Seeking, greater in addicts, and Self- Directedness, greater in general population. Conclusions: Data strongly suggest that observed differences are not previous, but consecutive to the addiction, it being apparent that the effects of the substances and the psychosocial conditions associated with their consumption are what exacerbates or blocks development of the traits. Findings are related to studies linking these variables with neuropsychological functions, and the inclusion of this neuropsychological perspective is strongly proposed for application to the assessment and treatment of addictive disorders.

Management of Addiction Disorders in Pregnancy

In this article, we will review the prevalence of addiction disorders in pregnancy and the impact that it has on perinatal morbidity and mortality. We will then review effective screening techniques and propose a management scheme for achieving short-term abstinence leading to the ultimate goal of long-term recovery. The various medical and obstetric complications unique to this patient population will be discussed as well as the specific adverse effects of substance abuse on placentation and the developing fetus. Finally, medications proven efficacious in the treatment of addiction disorders will be reviewed in the context of their use in the pregnant population.

Uses of Coercion in Addiction Treatment: Clinical Aspects

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

Bringing the Pieces Together: Relational Psychoanalysis and Harm Reduction Therapy in Treatment with Substance Abusers

For many years, there has been a rift between the fields of psychoanalysis and substance abuse treatment. Today, with the advent of a relational perspective in psychoanalysis and harm reduction therapy in addiction treatment, the two fields are coming together. This paper describes a relational psychoanalytic approach to treating addictions, defines harm reduction therapy, and elaborates how each can contribute to the other. Both harm reduction and relational psychoanalysis promote a context of mutuality and a collaboration between two fully functioning participants. With harm reduction as a background philosophy, relational psychoanalysis is ideally suited to the treatment of addictive disorders, especially in the ways relational analysts focus on process, self-states, and the use of transference, countertransference, and enactments. This paper elaborates the ways the analyst and patient can work together to recognize and integrate various dissociated self-states in the treatment.

Rebound of Weight Gain Following Topiramate Cessation

Glutamatergic system plays an important role in compulsive and/or addictive behaviors [5], which are associated with environmental cues [1]. Topiramate notably blocks the AMPA/kainate subtype of glutamate receptors [4]. Diverse studies and case reports have recently raised the interest of topiramate in the treatment of addictive disorders [6], obesity, and weight gain associated with antipsychotic drugs [2]. Despite this promising treatment for obesity [3], duration of treatment and its modality cessation remain understudied till to date.

Biotechnology and the Treatment of Addictive Disorders

Addiction is a chronic relapsing illness with onset typically occurring in the early teenage years, followed by cycles of drug use and abstinence. The disease is mitigated by complex interactions between genes and environment. Viewed as such, the treatment of addiction could span the whole lifetime of the patient and, ideally, should be tailored to the illness cycle. The search for effective treatments has intensified recently due to our better understanding of the underlying neurobiologic mechanisms contributing to drug use and relapse. The three main types of treatment are behavioral, pharmacologic and, more recently, immunologic therapies. Vaccines and monoclonal antibodies are being developed mainly for stimulant use disorders and nicotine addiction. In addition, new molecular targets identified by preclinical research have shown promise and are awaiting proof-of-concept studies in humans. The main focus of this review is on the development of immunotherapy for stimulants and nicotine addiction as a model highlighting the current status of the science and potential emerging discoveries and development.

Continuing care in the treatment of addictive disorders

Newer models of continuing care in the addictions are designed to improve the long-term management of substance use disorders by engaging patients into flexible, or "adaptive," treatment algorithms that change in focus and intensity as symptoms wax and wane over time. This article describes some of these newer approaches to the management of substance use disorders and presents recent research on their effectiveness. Findings suggest the following: 1) Continuing care interventions of a year or longer are more likely to show significant positive effects; 2) Continuing care treatments that are less burdensome to patients appear to promote higher rates of sustained engagement; 3) More structured and intensive continuing care may be more effective for patients with severe substance dependence and associated problems and for those who fail to achieve reasonable progress while in the initial phase of treatment; and 4) Use of medications as part of continuing care is increasing.

Increasing Executive and “Self—Soothing” Capacities in the Treatment of Addictive Disorders

Freud noted many years ago (1917/1963, 1933/1964) that the talking cure was developed due to the rather primitive nature of neuroscientific knowledge with regard to the brain and hence might eventually be made unnecessary or irrelevant by subsequent discoveries of the neuropsychological causation of neurotic symptoms. The opposite may be true, however. These discoveries may validate the potential effectiveness of therapeutic work with a wide variety of difficult personality disorders and addictive forms of pathology. The recent work of neuroscientists such as Barkley, Davidson, Goldberg, Schore and Volkow and Fowler may allow for empirical demonstrations of benign changes in brain functions following an effective course of treatment.

Preclinical evidence for GABA B agonists as a pharmacotherapy for cocaine addiction

A variety of studies indicate that GABA B receptor agonists may be useful in the treatment of addictive disorders. This brief review summarizes self-administration studies in rats which show that baclofen and other GABA B agonists may have specific effects on the reinforcing effects of cocaine. Preliminary clinical data with baclofen have also been encouraging. The obstacles and issues related to the use of GABA drugs in addiction therapy are briefly addressed.

Anticraving Medications for Relapse Prevention: A Possible New Class of Psychoactive Medications

Psychiatrists have gradually developed a list of medications that are effective in the treatment of addictive disorders. Although alcoholism has received the most attention, nicotine, heroin, and cocaine have all been shown to be influenced by heredity. Of course, the immediate goal is the reduction of drug craving and the prevention of relapse to compulsive drug taking. A medication that can aid in the maintenance of the opiate-free state is naltrexone, a specific opiate antagonist. Naltrexone is also a good example of an anticraving medication used in the treatment of alcoholism. Clinicians currently have two types of medication to aid in the treatment of tobacco use disorder, arguably the most important addiction. Bupropion and nicotine replacement can be given in a coordinated fashion to provide the best available results. At present, no medication is approved by the Food and Drug Administration for the indication of cocaine addiction. Recently, however, five different medications, already approved for other purposes, have been found to be effective among cocaine addicts. Despite clinical trials that show benefit, anticraving medications are not well known and are underused by clinicians. Addiction is a heterogeneous condition, with variability in reactivity to the drug of abuse and to the medications available to treat it. Recent developments in pharmacogenetics may result in improved selection of medications based on genotype.

Cue exposure therapy for opiate dependent clients

Cue exposure therapy is seen as a potentially effective treatment for addictive disorders. Drug‐dependent clients are repeatedly exposed to drug‐related stimuli and prevented from using drugs in an attempt to reduce reactivity to these stimuli. The present article gives an overview of cue reactivity models on which cue exposure therapy is based. An example of cue exposure practice is given, with a focus on opiate addiction. It is concluded that the few controlled studies that have been done do not show support for cue exposure therapy as an effective treatment for addictive disorders.

Relapse prevention for alcohol and drug problems: that was Zen, this is Tao.

Relapse prevention, based on the cognitive-behavioral model of relapse, has become an adjunct to the treatment of numerous psychological problems, including (but not limited to) substance abuse, depression, sexual offending, and schizophrenia. This article provides an overview of the efficacy and effectiveness of relapse prevention in the treatment of addictive disorders, an update on recent empirical support for the elements of the cognitive-behavioral model of relapse, and a review of the criticisms of relapse prevention. In response to the criticisms, a reconceptualized cognitive-behavioral model of relapse that focuses on the dynamic interactions between multiple risk factors and situational determinants is proposed. Empirical support for this reconceptualization of relapse, the future of relapse prevention, and the limitations of the new model are discussed.

Research Findings on Psychotherapy of Addictive Disorders

Psychoanalytically trained physicians working in methadone programs in the 1980s theorized that adding psychotherapy to addiction treatment would improve outcomes. Since then, a number of clinical studies have evaluated the effect of psychotherapy, drug counseling, and twelve-step intervention on treatment outcomes in methadone maintenance or cocaine and alcohol addiction programs. These studies have shown consistently that psychosocial treatments are helpful for patients with addictive disorders, with an effect size that ranges from mild to moderate. Major studies of psychotherapy in the treatment of addictive disorders are reviewed, and background information on psychotherapy and drug counseling is presented.

Employee Benefits Managers' Opinions About Addiction Treatment

Employee benefits managers arrange addictive disease treatment insurance coverage for the majority of people in the United States but little is known about these decision-makers. Managers were surveyed to learn their opinions about addiction treatment. Subjects were 131 people (61 percent female, 94 percent white, average age 46, average of 14 years in the human resources field). Managers were asked to rank health benefits (physical health, dental, alcohol-drug, vision, mental health, employee assistance program, and pharmaceuticals) on 15 dimensions. Managers ranked alcohol-drug abuse treatment worst on five items and second to the worst on another four of the 15 dimensions. On the item considered most important by the managers, respondents noted that employees often (2.8) ask for improved physical health benefits but rarely do so for alcohol and drug (4.1) benefits (p <.001). Education of workers and payers will be needed to change opinions about treatment of addictive disorders.