Showing papers on "Addiction medicine published in 2006"
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TL;DR: This work describes the following 4 models for the integration of buprenorphine maintenance therapy into HIV care: a primary care model, in which the highly active antiretroviral therapy-administering clinician also prescribes bupenorphine; a model that relies on an on-site specialist in addiction medicine or psychiatry to prescribe the bupranorphine, a hybrid model, and a drug treatment model.
Abstract: Opiate dependence among human immunodeficiency virus (HIV)-infected patients has been associated with negative clinical outcomes, yet few affected patients receive appropriate and coordinated treatment for both conditions. The introduction of buprenorphine maintenance therapy into HIV care settings provides an opportunity for providers to integrate treatment for opiate dependence into their practices. Buprenorphine maintenance therapy has been associated with reductions in opiate use, increased social stability, improved adherence to antiretroviral therapy, and lowered rates of injection drug use. We describe the following 4 models for the integration of buprenorphine maintenance therapy into HIV care: (1) a primary care model, in which the highly active antiretroviral therapy-administering clinician also prescribes buprenorphine; (2) a model that relies on an on-site specialist in addiction medicine or psychiatry to prescribe the buprenorphine; (3) a hybrid model, in which an on-site specialist provides the induction (with or without stabilization phases) and the HIV care provider provides the maintenance phase; and (4) a drug treatment model that provides buprenorphine maintenance therapy services with HIV services in the substance abuse clinic setting. The key barriers against effective integration of buprenorphine maintenance therapy and primary HIV services are discussed, and we suggest several mechanisms to overcome such obstacles.
61 citations
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TL;DR: The findings show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain, and there are implications for staff training, patient education, and further research.
Abstract: Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction. We used a vignette study to examine hospital staff judgments about patients with genuine symptoms of analgesic addiction and those with pain behaviors that merely resemble those symptoms. Nurses and doctors at hospitals in London, UK, judged the level of pain, the likelihood of addiction, and the analgesic needs of fictitious sickle cell disease patients. The patient descriptions included systematic variations to test the effects of genuine addiction, pain behaviors resembling addiction, and disputes with staff, which all significantly increased estimates of addiction likelihood and significantly decreased estimates of analgesic needs. Participants differentiated genuine addiction from pain behaviors resembling addiction when making judgments about addiction likelihood but not when making judgments about analgesic needs. The treatment by staff of certain pain behaviors as symptoms of analgesic addiction is therefore a likely contributory cause of inadequate or problematic hospital pain management. The findings also show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain. There are implications for staff training, patient education, and further research.
43 citations
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TL;DR: The addictions field will need to speak with a united voice to ensure that neurosurgical treatment of addiction is not introduced into developed countries by enthusiastic private practitioners without formal evaluation, as purported 'cures' for heroin addiction all too often are.
Abstract: Over the past 4 years Russian and Chinese surgeons have used neurosurgical procedures to treat heroin addiction. 305 were reportedly operated on in Russia and over 500 in China before the procedure was stopped by the Russian and Chinese governments in 2002 and 2004. The addictions field will need to speak with a united voice if we are to ensure that neurosurgical treatment of addiction is not introduced into developed countries by enthusiastic private practitioners without formal evaluation, as purported 'cures' for heroin addiction all too often are. We must also be prepared to face the challenge that may arise if neurosurgical entrepreneurs in developing countries with poorly regulated medical care and punitive policies towards opioid addiction begin to market neurosurgery as an addiction 'cure'. If this happens, clear and consistent statements of the case against pursuing this desperate remedy will be required from credible organizations, such as the World Health Organization.
39 citations
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TL;DR: The neurobiological factors underlying the addiction process, available pharmaceutical treatment, and how recent research regarding the neurobiology of addiction affects occupational therapy's role in addiction rehabilitation are discussed.
Abstract: Approximately 200 million people in the United States have an addiction disorder that significantly disrupts employment, family relationships, financial stability, and personal health. As a result, addiction has become one of the most critical health care challenges presently facing the American health care system. Research in the last five years has provided substantial evidence that addiction is a neuro-biological condition rooted in genetic factors. During the addiction process neurologic changes occur that are responsible for tolerance, craving, and relapse. It appears that once addiction becomes chronic, the brain enters an addicted state that may be irreversible without pharmaceutical intervention. Such alterations in neurochemistry-rather than poor volitional control-account for why addiction is characterized by a chronic, relapsing-remitting course. This paper discusses (a) the neurobiological factors underlying the addiction process, (b) available pharmaceutical treatment, and (c) how re...
38 citations
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13 citations
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TL;DR: These and other potential explanations for the paradoxically low placement of the addiction treatment industry among other socially important institutions in the United States are explored.
12 citations
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TL;DR: It is suggested that addiction researchers need to look beyond the question of whether an intervention is "effective" and examine the community context within which those interventions are delivered and add this health services view to compliment clinical trials research.
10 citations
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TL;DR: Intensive addiction treatment environments present an outstanding opportunity to help trauma survivors with substance use disorder (SUD) and only relatively recently has trauma become more accepted as a legitimate focus for work in addiction treatment.
Abstract: Intensive addiction treatment environments present an outstanding opportunity to help trauma survivors with substance use disorder (SUD). Typically, such environments provide an array of group therapies, close monitoring by staff, and peers with whom to connect. However, only relatively recently has trauma become more accepted as a legitimate focus for work in addiction treatment.
7 citations
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3 citations
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TL;DR: The authors explored changes in treatment staffs' knowledge, beliefs, and cross-disciplinary collaboration over the course of the 22.5 hour training and found that participants benefited from exposure to content outside their respective discipline.
Abstract: Cross-training professionals from mental health and addiction treatment systems can help further the goal of comprehensive treatment for clients with co-occurring mental health and substance use disorders (co-occurring disorders). Two such trainings brought together 122 professionals from mental health and addiction treatment fields. This evaluation study explored changes in treatment staffs' knowledge, beliefs, and cross-disciplinary collaboration over the course of the 22.5 hour training. Results suggest that participants benefited from exposure to content outside their respective discipline, and knowledge of co-occurring disorders and treatment for co-occurring disorders improved. Both groups of professionals endorsed similar beliefs about the nature and etiology of addiction over the course of the training. Differences emerged in participants' views about cross-disciplinary collaboration, with addiction treatment professionals reporting more agency collaboration. Participants favored aspects ...
2 citations
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TL;DR: The emergency department (ED) is a frequent provider of services to those addicted to alcohol or drugs, and which specialist services the ED needs to be able to access in order to provide a safe and high quality service to addicts in their care is reviewed.
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TL;DR: In the clinical context, addiction puts problem substance use on the agenda, and helps focus on the difficulties associated with drug use, but the concept is also used to distance the user from addicts, and in this way, may be counter-therapeutic.
Abstract: Addiction is compulsive need for and use of a habit-forming substance. It is accepted as a mental illness in the diagnostic nomenclature and results in substantial health, social and economic problems. In the diagnostic nomenclature, addiction was originally included in the personality disorders along with other behaviours considered deviant. But it is now considered a clinical syndrome. Addiction is multifactorially determined, with substantial genetic influence. The development of addictions is also influenced by environmental factors, and an interplay between the two. In the clinical context, addiction puts problem substance use on the agenda, and helps focus on the difficulties associated with drug use. But the concept of addiction is also used to distance the user from addicts, and in this way, may be counter-therapeutic. The addiction concept has also had a substantial influence on policy. The almost universal prohibition against drugs such as opiates, cocaine, cannabis and amphetamine has much support. But unfortunately, it has not been able to hinder the development of substance use problems. Optimism is fostered by the development of respectful ways of thinking about people with addictions, in particular, from advocates of motivational interviewing.
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TL;DR: This book argues effectively in favour of a blended approach that will best allow clinicians to meet patients according to where they are along the continuum of substance use problems to facilitate both overall functional improvement and moving toward, or becoming, abstinent.
Abstract: Substance Abuse Treating Alcohol and Drug Use Disorders in Psychotherapy Practice: Doing What Works Arnold M Washton, Joan E Zweben. New York (NY): Guilford Press; 2006. 312 p. US$35.00. Reviewer Rating: Excellent Review by David Crockford, MD, FRCPC, DABPN Calgary, Alberta Substance use disorders are highly prevalent in psychiatric practice and can limit the effectiveness of psychiatric interventions. Unfortunately, many psychiatrists have little training in the management of substance use disorders and thus feel ill-equipped to treat patients with comorbid substance use problems. Although several excellent textbooks are available on substance use disorders, few books have been written that translate textbook knowledge into a means to address alcohol and drug problems competently and routinely in the patients seen in clinical practice. This book does not attempt to be a definitive source of current empirical evidence; instead, it focuses on the application of evidence to clinical practice as a "how to" guide, and it does so admirably. While it is aimed at psychotherapists in private practice, it is highly applicable to psychiatry residents, psychiatrists in practice, and specialists in addiction medicine or psychiatry. It reads easily and in the manner of an expert clinician providing experienced and step-by-step advice on how to care for substance-using patients, identifying practical strategies and potential pitfalls. Its clinical orientation blends together seemingly disparate treatment approaches, including 12-step-oriented, abstinence-based addiction counselling; harm reduction; cognitive-behavioural therapy; motivational interviewing; dynamic psychotherapy; and pharmacotherapy. The book argues effectively in favour of a blended approach that will best allow clinicians to meet patients according to where they are along the continuum of substance use problems to facilitate both overall functional improvement and moving toward, or becoming, abstinent. Part I of this book, titled "Basic Issues and Perspectives," provides a clinically focused and reasonably up-to-date review of current theoretical views on substance use disorders, actions of specific substances, the role of comorbidity, and the place for pharmacotherapy. It emphasizes the need to address substance use problems in clinical practice and the basis for choosing a blended therapeutic approach. For less experienced clinicians, Chapter 3 provides an excellent tutorial on the psychoactive substances, but it is also replete with clinical pearls (for example, on the link between stimulant drugs and sexual behaviour and on controversies regarding benzodiazepines) that experienced clinicians will readily identify with. Chapter 4 is another strong chapter that describes how an integrated approach uses the stages of change model to alter the treatment approach according to current stage of change and how to incorporate concepts from motivational interviewing, the disease model, self-medication, and self-help program facilitation into the seamless care of patients. Part II of the book, "Clinical Strategies and Techniques," presents practical approaches to the substance-using patient. This is the book's forte and the reason I highly recommend it. Chapter 7 describes how to perform an assessment for substance use disorders that may be overly detailed for some clinicians but shines in its description of how to offer clinical feedback from the assessment, assess stage of change, and facilitate treatment engagement. Chapter 8 is exceptional in its explanation of the process of setting treatment goals and how to match appropriate motivational strategies to each stage of change, further summarized in an easily referred-to table. Chapter 9 describes techniques for active intervention, including cessation techniques and managing withdrawal, using random drug screens, establishing adequate structure, developing a recovery support system, addressing other substances of abuse, early recovery psychotherapy, and managing triggers, cravings, and urges. …
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