Showing papers on "Addiction medicine published in 1996"

Opioid therapy for chronic nonmalignant pain

Abstract: Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

Addiction or compulsion: Politics or illness?

Abstract: Confusion exists about the use of the terms addiction and compulsion. In the case of sexual addiction and compulsion, the issues seem to be more volatile. In part this reflects our cultural ambivalence about sex, and in part this reflects professional ambivalence about sex addiction. This article summarizes the clinical usage of the terms sexual addiction and sexual compulsion and the issues that result across five separate disciplines: sexual medicine, addiction medicine, trauma medicine, psychiatry, and criminal justice rehabilitation. The summary reveals many parallels in the five disciplines and their reactions to the terms sexual addiction and sexual compulsion. Research across the disciplines points to a paradigm shift which may resolve issues of clinical understanding of the terms.

The role of internal medicine in addiction medicine.

Abstract: Internal Medicine must play an important role in addiction medicine. Although Psychiatry has been the dominant discipline in the addictions field, this article explores how the internist can bring special insight to the understanding of addictions. The article documents how Internal Medicine, historically, has helped define and diversify the field of addiction medicine. A survey of recent history, however, shows that Internal Medicine has only minimally broadened its role in the addiction field, despite the pronouncements of numerous committees, despite the urging of several medical groups that it do so. The article shows that some internists want to play an increased role in the field of addiction medicine, but often feel limited by their lack of knowledge and by the professional biases they confront. In conclusion, new suggestions for improving internist education and increasing their interest and participation in addiction medicine are offered.

Electrostimulation: Addiction Treatment for the Coming Millennium

Abstract: At a period of fundamental review of the health care system, it is timely to re-assess one of medicine's most intractable problems—the treatment of addictions. The apparently insoluble dilemmas pos...

Tobacco Addiction-Reply

Abstract: In Reply. —Dr Lyman's concern that we did not mention nicotine as an addictive drug was echoed by several of our colleagues. Nicotine is increasingly being viewed as an addictive drug among addiction medicine specialists; however, smoking cessation treatment is often provided separately from treatment of other chemical dependencies and is generally not provided as part of the treatment of alcohol and other drug disorders. Most people who are dependent on alcohol and other drugs smoke cigarettes. A recently published study 1 reported the cumulative mortality from tobaccorelated causes (50.9%) among patients previously treated for alcohol and other drug dependencies exceeded that of alcohol (36.0%). As a practical matter, patients undergoing treatment for alcohol or other drug dependencies are often resistant to stopping smoking while they are undergoing treatment. A common response is, "Yes, I want to stop, but not now." Insurers and managed care organizations generally will not pay extra for