Showing papers on "Addiction medicine published in 2003"

Addiction Treatment: A Strengths Perspective

Abstract: This book presents the strengths perspective as the unifying framework of the text to bridge the gap between 12-step approaches and harm reduction in addictions treatment. This perspective is applied to the treatment of alcoholism, eating disorders, compulsive gambling, and other addictions. The biopsychosocial framework is the organizing framework for this text. Divided into four parts, ADDICTION TREATMENT is comprised of three core sections that cover the biology, psychology, and social aspects of addiction respectively.

Physicians’ opinions about medications to treat alcoholism

Abstract: Aims Medications play a limited role in the treatment of alcoholism. This paper examines physicians’ opinions about and use of two alcoholism medications currently approved in the US—disulfiram and naltrexone—and one alcoholism medication—acamprosate—that might be approved. Design A total of 1388 substance abuse specialist physicians who were members of the American Academy of Addiction Psychiatry or the American Society of Addiction Medicine completed a questionnaire in 2001 (65% response rate). Findings The average percentages of physicians’ patients with alcoholism who were prescribed the following medications were: 13% (naltrexone), 9% (disulfiram), 46% (antidepressants) and 11% (benzodiazepines). Almost all physicians had heard of naltrexone and disulfiram, but their self-reported level of knowledge about these medications was lower than for antidepressants. Physicians estimated that naltrexone had a small-to-medium effect size, which was similar in magnitude to the effect size reported in recent meta-analyses of randomized clinical trials. Physicians identified the following three courses of action as the most likely to result in greater use of medications to treat alcohol dependence: more research to develop new medications (33%), more education of physicians about existing medications (17%), and increased involvement of physicians in alcoholism treatment (17%). Conclusions Physicians’ low rate of use of naltrexone may reflect its small-to-medium effect size.

Effect of primary medical care on addiction and medical severity in substance abuse treatment programs.

Abstract: OBJECTIVE: To examine whether the availability of primary medical care on-site at addiction treatment programs or off-site by referral improves patients’ addiction severity and medical outcomes, compared to programs that offer no primary care.

Addiction Brain Disease, and It Matters

Abstract: Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society’s overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.

Accessibility of addiction treatment: results from a national survey of outpatient substance abuse treatment organizations

Abstract: Objectives This study examined organization-level characteristics associated with the accessibility of outpatient addiction treatment.

Addiction, Physical Dependence, and Tolerance

Abstract: Pain is among the most common complaints for which people seek medical care; yet pain is also among the most undertreated patient complaints. Reasons for this include reluctance by clinicians to prescribe and support the use of opioids, often due to a fear of addiction. To address this issue, three major health professional organizations that deal with the treatment of pain and addiction, the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine, formed the Liaison Committee on Pain and Addiction (LCPA). The first mission of the LCPA was to formulate precise definitions of the terms addiction, physical dependence, and tolerance. This report explains these definitions and discusses how they apply to clinical practice.

Treatment of sleep disturbance in alcohol recovery: a national survey of addiction medicine physicians.

Abstract: Sleep disturbance is common among patients in recovery from alcoholism and can precipitate relapse. Though sleep complaints are commonly managed with medication, little is known about their management among recovering alcoholic patients. We performed a postal survey of a self-weighted, random systematic sample of 503 members of the American Society of Addiction Medicine (ASAM) to examine addiction medicine physicians' medical management of sleep disturbance among patients in early recovery from alcoholism. After 3 mailings, 311 (62%) responded. Of responents, 64% have offered pharmacological treatment to an insomniac, alcoholic patient in the first 3 months after detoxification, but only 22% offered medication to more than half of such patients. Trazodone was the preferred therapy, chosen first by 38% of respondents, followed by other sedating antidepressants (12%), and antihistamines (12%). The mean duration of therapy for trazodone and other sedating antidepressants exceeded one month. Experts in addiction medicine appear reluctant to prescribe medication to sleep-disturbed patients in early recovery from alcoholism. When they do prescribe, trazodone, other sedating antidepressants and antihistamines are favored, despite limited evidence for or against this indication. Although the treatment of disordered sleep among alcoholic patients in early recovery may have merit to prevent relapse, controlled studies of these sleep agents are needed.

Information-seeking behavior in complementary and alternative medicine (CAM): an online survey of faculty at a health sciences campus.

Abstract: Background: The amount of reliable information available for complementary and alternative medicine (CAM) is limited, and few authoritative resources are available Objective: The objective is to investigate the information-seeking behavior of health professionals seeking CAM information Methods: Data were gathered using a Web-based questionnaire made available to health sciences faculty affiliated with the University of California, San Francisco Results: The areas of greatest interest were herbal medicine (67%), relaxation exercises (53%), and acupuncture (52%) About half the respondents perceived their CAM searches as being only partially successful Eighty-two percent rated MEDLINE as a useful resource, 46% personal contacts with colleagues, 46% the Web, 40% journals, and 20% textbooks Books and databases most frequently cited as useful had information about herbs The largest group of respondents was in internal medicine (26%), though 15% identified their specialties as psychiatry, psychology, behavioral medicine, or addiction medicine There was no correlation between specialty and patterns of information-seeking behavior Sixty-six percent expressed an interest in learning more about CAM resources Conclusions: Health professionals are frequently unable to locate the CAM information they need, and the majority have little knowledge of existing CAM resources, relying instead on MEDLINE Medical librarians need to educate health professionals in the identification and use of authoritative CAM resources

Treatment of pain in pregnancy.

Abstract: Background The treatment of pain during pregnancy other than that of labor is a clinical issue that has not been addressed in a systematic manner. Materials and methods To assess current knowledge, a review of the human and animal literatures was undertaken using MEDLINE. In addition, the dynamics of three pharmacological compartments, the mother, the placenta, and the fetus, and fate of drugs given in pregnancy, was reviewed. Results The literature review yielded little information except for a few case studies in which opiates, nonsteroidal anti-inflammatory drugs, antidepressants, mu agonists, and anticonvulsants were used in the treatment of pain in pregnancy. In contrast, there is extensive information in the addiction medicine literature concerning the use of opioids in recovering pregnant addicts. Methadone, buprenorphine, and morphine have been used to treat women seeking recovery from opioids, and neonatal outcomes have been closely monitored with no evidence of harm to the newborn. Conclusions Experience in women seeking recovery from opioids and their newborns illustrates that opioids are an effective and safe pharmacological option for the treatment of pain during pregnancy. Controlled studies are needed to expand knowledge in this clinical area.

Triple diagnosis: dual diagnosis and HIV disease, Part 1.

Abstract: Substance use disorders and psychiatric illness commonly co-occur in what is known as dual diagnosis. With the spread of HIV infection in persons with dual diagnoses, the triple diagnosis has emerged as a clinically challenging condition for primary care physicians, addiction medicine specialists, and psychiatrists. Existing data support the high prevalence of triple-diagnosis patients in psychiatric, substance abuse, and HIV treatment settings. This review highlights the features of substance abuse-psychiatric illness and its association with changes in antiretroviral therapy use, adherence, and HIV treatment outcomes. An integrated and interdisciplinary approach addressing substance abuse and mental health issues should be a primary element of comprehensive HIV care. Evaluating the safety and efficacy of psychopharmacologic and psychotherapeutic interventions and understanding the complex interactions among the components of the triple diagnosis are areas for future research. Service delivery and intervention models based on "1-stop shopping" should be developed and put into practice in order to optimize clinical outcomes.

Guidelines for the Use of Controlled Substances in the Management of Chronic Pain

Abstract: Controlled substance abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of controlled substances, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. The primary objective of controlled substance guidelines by American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of controlled substances for the treatment of chronic pain. It is anticipated that these practical guidelines will improve quality of care, patient access, and quality of life. Additional benefits include improved treatment efficiency and efficacy, and cost containment by improving the risk-benefit ratio of treating patients with chronic pain. Further goals of this manuscript are to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic pain patients with medically appropriate controlled substances, and to reduce the incidence of drug diversion. These guidelines also reinforce the need for systematic evaluation and ongoing care of patients with chronic or persistent pain. ASIPP controlled substance guidelines also provide a discussion of the epidemiology of chronic pain, the role of controlled substances in treating chronic pain, various aspects of drug abuse, pharmacological considerations, clinical effectiveness of controlled substances, options for treatment monitoring and drug testing and a review of terminology used in addiction medicine. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, controlled substance prescribing and treatment different from that outlined here may be warranted. These guidelines do not represent "standard of care."

Drug addiction and its treatment

Abstract: Few problems are as complicated as drug misuse. Drug addiction is a major public health issue with implications for healthcare systems and society at large. As well as expenditure on prevention, treatment and rehabilitation, costs are also incurred by the welfare, social service and the criminal justice systems. In addition, there are further human costs associated with impaired health, damaged relationships and lowered productivity. This book is about treatment options. The history of addiction treatment has been characterised by fads and fashions. Some of the treatments used have been, at best ineffective, at worse harmful, and occasionally even dangerous. However, in the past two decades, many promising treatment interventions and procedures, and new therapeutic agents have been developed. Different forms of psychological treatments have been tested and provided in a systematic manner. There are a range of pharmacological options where once there were few. Most importantly, there is increasing evidence about the effectiveness of many of these treatments, and there is a clearer understanding of the importance of the social, environmental, behavioural and cognitive processes involved, as well as the use of active coping strategies during recovery. Addiction treatment involves a variety of different practices and procedures used with different populations and which are designed to achieve different goals. Drug Addiction and its Treatment explains why no single treatment is effective for everyone with a drug addiction problem. Treatment is provided by a range of personal from differing backgrounds and in a range of settings. This book should be read by psychiatrists, clinical psychologists, social workers, nurses, policy makers, service managers, and researchers with an interest in addiction.

The Historical Context of Addiction in the Nursing Profession: 1850-1982.

Abstract: Intertwined in the history of substance abuse in the United States is the history of addiction in the nursing profession. This historical research explores the context of addiction in the nursing profession with reference to social, medical, political, and legal events from 1850 until the American Nurses' Association officially acknowledged addiction in the nursing profession in 1982 with guidelines for the impaired nurse. Prior to these guidelines colleagues looked the other way hoping the nurse would solve the problem by herself or if not, just leave. If caught, punitive action was taken. Nurses lost their licenses, their source of income (meaning no resources for rehabilitation treatment), and often went to jail.

Healing Addiction: An Integrated Pharmacopsychosocial Approach to Treatment

Abstract: Filled with helpful resources and illuminating case studies, Healing Addiction provides you with an integrative guide to understanding and treating addiction that brings together the latest neuroscience, pharmacology, social understanding, and psychological research. It is a key resource for professionals in the addiction community, for social scholars and policymakers, and for the interested general reader.

Addiction Is a Brain Disease, and It Matters

Abstract: Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society’s overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction.

In-Office Opiate Treatment Not a Panacea

Abstract: ADRUG TRUMPETED AS A MAJOR ADvance in opiate addiction treatment is garnering a tepid response from physicians, despite its status as the first such treatment available outside licensed drug treatment clinics. Bureaucratic hurdles, lack of clinical guidelines, and unfamiliarity with addiction have all hampered physician adoption of the drug, buprenorphine. While less strictly regulated than methadone, buprenorphine can be prescribed only by physicians who complete an eight-hour course and register with the Department of Health and Human Services and the Drug Enforcement Agency (DEA). But even after receiving a special DEA number, individual physicians and physician group practices—no matter how large—are limited by law to 30 buprenorphine patients, a figure several people interviewed for this article called absurd. “That [limit] is going to have to change before there’s widespread use,” said Michael G. Hayes, MD, director of the Center for Addiction Medicine, part of the University of Maryland Medical System, Baltimore. Since October 2002, when the US Food and Drug Administration (FDA) approved two formulations of buprenorphine, some 3000 physicians have undergone training sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and offered by various professional societies ( JAMA. 2003;289:690). However, as of late June, only 1900 had applied for the requisite waiver, said Robert Lubran, MPA, MS, director of the division of pharmacological therapies at SAMHSA. “About 1000 haven’t applied and, frankly, we don’t know why,” Lubran said. He speculated that some physicians attend training and then decide

Recent Developments in Alcoholism — Vol. 15. Services Research in the Era of Managed Care.

Abstract: This is the 15th volume in a series which has a well-established reputation for providing authoritative and up to date information about alcohol and alcohol misuse. During the past 10 years ‘managed care’ has transformed the character of treatment for individuals in the USA. Many believe this has rationed and constrained treatment to the detriment of patients, while others contend that it has simply brought about overdue rationalization, rather than rationing. The American Society of Addiction Medicine, of which this is an official publication, believes that managed care has been associated with a drastic reduction in the frequency and duration of in-patient hospitalization which has not been balanced by a corresponding increase in the availability and prevalence of out-patient treatment. Most treatment programmes for alcohol problems are governed by the system of ‘managed behavioural healthcare’, which aims to control cost and maintain quality. The UK National Health Service is very familiar with trying to balance this equation. The complexities …

Integrating medical care and addiction treatment.

Abstract: The segregation of addiction treatment and medical care is an unfortunate consequence of policies and practices that have developed in the United States over many years. New research points toward the benefits of integrating these 2 systems of care, and the development of new behavioral and pharmacologic treatments for addiction is destined to render their separation increasingly untenable. However, movement toward integration faces substantial regulatory and political obstacles.

'Medicamenteuze interventies bij drugverslaving'; een advies van de Gezondheidsraad

Abstract: Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient category.

Addiction to Prescription Analgesics and Minor Tranquilizers: A Case Study of Hidden Primary Addiction

Abstract: Addiction to prescription analgesics and psychotropic drugs consistently remains a greater addiction problem for women than men. This case study of a 30-year-old white, middle class female teacher characterizes a pattern of primary addiction to prescription drugs common to women of all ages. This case history consists of in-depth interviews in which the respondent first traces the predisposing factors to her addiction, then describes the underlying health problems that led to the prescriptions, elaborates the intricate schemes for obtaining medication, discusses the altering issues of pain and panic, and delineates the comprehensive rehabilitation program that successfully changed her behavior. The respondent offers insights leading to recommendations for prevention of the addiction, recognition of the addictive symptoms, and suggestions for surviving with chronic pain but without addictive mediations.

What do obstetric textbooks teach about alcohol in pregnancy

Abstract: Pregnancy is a critical time. Women are often more receptive to change, as they tend to focus on positive health behaviors. Trained physicians who are knowledgeable in this field and feel comfortable discussing alcohol use during pregnancy can play a central role in the prevention of alcoholrelated birth defects through early detection and intervention, appropriate referrals, and education of the mother. Therefore, inclusion of current recommendations on alcoholrelated issues during pregnancy in medical textbooks, and acceptance of addiction medicine as part of medical school curriculum and mainstream practice is essential.