Showing papers on "Addiction medicine published in 2007"

Cognitive Behavior Therapy with Internet Addicts: Treatment Outcomes and Implications

Abstract: Research over the last decade has identified Internet addiction as a new and often unrecognized clinical disorder that impact a user's ability to control online use to the extent that it can cause relational, occupational, and social problems. While much of the literature explores the psychological and social factors underlying Internet addiction, little if any empirical evidence exists that examines specific treatment outcomes to deal with this new client population. Researchers have suggested using cognitive behavioral therapy (CBT) as the treatment of choice for Internet addiction, and addiction recovery in general has utilized CBT as part of treatment planning. To investigate the efficacy of using CBT with Internet addicts, this study investigated 114 clients who suffered from Internet addiction and received CBT at the Center for Online Addiction. This study employed a survey research design, and outcome variables such as client motivation, online time management, improved social relationships, improv...

Assessing the Dual Diagnosis Capability of Addiction Treatment Services: The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index

Abstract: Background: Addiction treatment systems and services are increasingly challenged to provide effective treatments for persons with co-occurring disorders. Evidence-based practices are still being developed, and practice benchmarks remain vague in guiding treatment providers in enhancing services, or in delineating standards with which to evaluate the quality of existing care for persons with dual disorders. The American Society of Addiction Medicine (ASAM) proposed a taxonomy of addiction treatment program dual-diagnosis capability, and provided a conceptual model of services for persons with co-occurring substance use and psychiatric disorders. Method: This article describes the development and application of the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index, which is designed to assess the dual diagnosis capability of addiction treatments services, and is based upon the ASAM taxonomy: Addiction Only Services (AOS), Dual Diagnosis Capable (DDC) or Dual Diagnosis Enhanced (DDE). R...

Improving drug addiction treatment in China.

Abstract: Aims To illustrate the current situation and problems of drug addiction in treatment China and propose suggestions. Methods A descriptive study based on literature searched from Medline and the China National Knowledge Infrastructure database (1996–2007) and hand-picked references. Results Since the re-emergence of drug addiction in China in the early 1990s, there has been tremendous progress in drug addiction treatments in China, especially treatments for opiate addiction. However, many problems and challenges remain for improvement, including widespread negative attitudes towards drug abuse and drug-dependent individuals, the lack of evidence-based data on the efficacy of Chinese traditional medicine and the lack of a comprehensive and integrated system to organize all treatment resources and monitor treatment progress. The authors discuss the challenges that impede effective treatments of drug addiction and some suggestions are proposed. Implementing these suggestions can improve the outcome of treatment of drug-dependent individuals and benefit the whole society. Conclusion China faces substantial drug addiction problems that appear to be worsening with time. Although much progress in drug addiction treatment has been made, improvement in many aspects is needed urgently.

Substitution treatment for opioid addicts in Germany

Abstract: After a long and controversial debate methadone maintenance treatment (MMT) was first introduced in Germany in 1987. The number of patients in MMT – first low because of strict admission criteria – increased considerably since the 1990s up to some 65,000 at the end of 2006. In Germany each general practitioner (GP), who has completed an additional training in addiction medicine, is allowed to prescribe substitution drugs to opioid dependent patients. Currently 2,700 GPs prescribe substitution drugs. Psychosocial care should be made available to all MMT patients. The results of research studies and practical experiences clearly indicate that patients benefit substantially from MMT with improvements in physical and psychological health. MMT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. MMT is also seen as a vital factor in the process of social re-integration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10 % of MMT patients become drug-free in the long run. Methadone is the most commonly prescribed substitution medication in Germany, although buprenorphine is attaining rising importance. Access to MMT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in MMT, although regular employment is considered unanimously as a positive factor of treatment success. Substitution treatment in German prisons is heterogeneous in access and treatment modalities. Access is very patchy and the number of inmates in treatment is limited. Nevertheless, substitution treatment plays a substantial part in the health care system provided to drug users in Germany. In Germany, a history of substitution treatment spanning 20 years has meanwhile accumulated a wealth of experience, e.g. in the development of research on health care services, guidelines and the implementation of quality assurance measures. Implementing substitution treatment with concomitant effects and treatment elements such as drug history-taking, dosage setting, co-use of other psychoactive substances (alcohol, benzodiazepines, cocaine), management of 'difficult patient populations', and integration into the social environment has been arranged successfully. Also psychosocial counseling programmes adjuvant to substitution treatment have been established and, in the framework of a pilot project on heroin-based treatment, standardised manuals were developed. Research on allocating opioid users to the 'right' form of therapy at the 'right' point in time is still a challenge, though the pilot project 'heroin-based treatment' brought experience with patients who do not benefit from methadone treatment. There is also expertise in the treatment of specific co-morbidity such as HIV/AIDS, hepatitis and psychiatric disorders. The promotion and involvement of self-help groups plays an important part in the process of successful substitution treatment.

Day hospital and residential addiction treatment: Randomized and nonrandomized managed care clients.

Abstract: Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization and directed to residential treatment because of high environmental risk (n=82). American Society of Addiction Medicine criteria defined study and randomization eligibility. More than 50% of followed clients reported past-30-day abstinence at follow-ups (unadjusted rates, not significant between groups). Despite differing baseline severities, randomized, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models. Index treatment days and 12-step attendance were associated with abstinence (p<.001). Other prognostic effects (including gender and ethnicity) were not significant predictors of differences in outcomes for clients in the treatment modalities. Although 12-step attendance continued to be important for the full 12 months, treatment beyond the index stay was not, suggesting an advantage for engaging clients in treatment initially and promoting 12-step attendance for at least a year.

Drug and alcohol abuse: a clinical guide to diagnosis and treatment

Abstract: Authored by Marck A Schuckit. Published by Springer, New York, 2006, $52.04, pp 404. ISBN 13.978-0387-25732-7 As the subtitle indicates, Drug and alcohol abuse is a clinical guide, no more, no less. The fact that it is in its sixth edition shows that it sums up important and indispensable information for specialists working in clinical addiction medicine, ranging from the basic concepts of addiction medicine, through the diagnostic criteria of the different addictive syndromes, to the specific treatment methods. Right in the first chapter the author emphasises that the book has undergone considerable changes and development since the appearance of the first edition (1979). A separate study could be made of the contemporary development of addiction science by comparing the different editions. In each edition, in defining the priorities for the different drugs, Schuckit takes into account how popular the particular substance is with users at the time. As a result, this edition contains no information on …

No-Show for Treatment in Substance Abuse Patients with Comorbid Symptomatology: Validity Results from a Controlled Trial of the ASAM Patient Placement Criteria.

Abstract: Purpose:Mismatched placement, according to the American Society of Addiction Medicine's (ASAM) Patient Placement Criteria (PPC), promotes no-shows to treatment; however, little is known about the impact on patients with psychiatrically comorbid substance use disorder.Methods:In a multisite trial, pu

The Journal of Inebriety (1876–1914): history, topical analysis, and photographic images

Abstract: Aims The publication of the Journal of Inebriety (1876–1914) chronicled the rise and fall of the first era of organized addiction medicine in the United States. Methods Findings from historical research, a content analysis of the Journal's 35 volumes and 141 issues and images from the Journal illustrate visually the medical treatment of addiction in the United States in the late 19th and early 20th centuries. Results Under the editorial direction of Dr T. D. Crothers, the Journal of Inebriety published papers and reviews focused primarily on the medical treatment of alcohol and opiate addiction within a growing international network of inebriate homes and asylums. Conclusions The history of the Journal of Inebriety mirrors efforts in America to forge a legitimized field of addiction medicine amid conflicting conceptualizations of the nature of severe alcohol and other drug problems.

Improving physician and medical student education in substance use disorders.

Abstract: Medical and psychosocial problems related to substance use disorders (SUDs) remain a major source of national morbidity and mortality. This situation exists despite greater understanding of genetic, neurobiologic, and social underpinnings of the development of these illnesses that has resulted in many advances in addiction medicine. The value of assessment and brief intervention of this disease is well documented. Patients need to be identified and engaged in order for them to be treated. A variety of evidence-based pharmacologic and psychotherapeutic treatments are now available. Strong evidence exists that treatment of patients for SUDs produces results similar to or better than those obtained from treatment for other chronic illnesses. It is also clear that physicians can play a pivotal role in helping to reduce the burden of disease related to SUDs However, to do this, physicians need to be better educated. Through such education comes greater confidence in identification and providing treatment. Also, the discomfort and stigma often associated with this disease are reduced. The federal government-through the Office of National Drug Control Policy, the Surgeon General, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Highway Traffic Safety Administration of the Department of Transportation (DOT)-is expending concerted efforts to improve physician education in addiction medicine. These efforts culminated in the Second Leadership Conference on Medical Education in Substance Abuse in December 2006. The osteopathic medical profession was represented at this conference. This article reviews not only the recommendations from this meeting, but also the nature of the problem, how members of the osteopathic medical profession are currently addressing it, and a strategy for improvement endorsed by the American Osteopathic Academy of Addiction Medicine.

Overcoming fears, frustrations, and competing demands: an effective integration of pain medicine and primary care to treat complex pain patients.

Abstract: In the United States, the number of pain specialists is insufficient to manage the tens of millions of patients suffering from chronic pain. Also, multidisciplinary pain clinics are on the “endangered list” and not widely available. Therefore, most patients with pain are being managed in the primary care setting. Primary care providers (PCPs) encounter patients daily with chronic pain and its attendant comorbidities, but may lack the knowledge, experience, and time to tackle all the complexities involved—frustrating both patients and providers. PCPs have become increasingly aware of research documenting the under-treatment of pain, but feel unprepared to adequately address this public health problem because of their limited training in pain and addiction medicine [1], and are inexperienced in the nuances of using opioids, treatment agreements, and urine drug tests. Time pressures are faced routinely by PCPs. While these pressures are not unique to primary care; juggling a variety of competing demands by PCPs is unique and may be particularly onerous [2]. In addition to addressing patients' acute complaints and concerns at a particular visit, PCPs are expected to manage several comorbid chronic diseases (diabetes mellitus, hypertension, heart disease, and many others), provide preventative care (cancer screening and vaccinations), offer counseling and education, order indicated laboratory and radiographic …

Update in addiction medicine for the generalist.

Abstract: Generalist physicians can play a critical role in identifying and treating patients with addictions to alcohol, nicotine, and/or other drugs of abuse. In the United States, nicotine dependence and unhealthy alcohol use are the first (18.1%) and third (3.5%) leading causes, respectively, of preventable deaths.1 Primary care physicians have not traditionally treated substance use despite the harmful effects that addiction can cause in their patients. The objective of this paper is to present recent evidence on recognizing and treating addiction disorders that is relevant for generalist physicians. We conducted an electronic database (PubMed) search to systematically identify recent (January 1, 2003, to June 1, 2006), human subject, English language, peer-reviewed, research articles or publications that impact generalist care for patients with addiction disorders. The search strategy and consensus deliberations were used to identify important articles in the categories of screening strategies for patients with alcohol problems and use of specific pharmacotherapies for patients with alcohol, nicotine, and opioid dependence.

Effect of Drug Addiction on the Biopsychosocial Aspects of Persons with Addiction in Kuwait: Nursing Implications

Abstract: Addiction is often seen as a “family illness” that has biological, psychological, and socio-cultural aspects that should be taken into consideration in order to achieve successful treatment and pre...

Romancing Opiates – Pharmacological Lies and the Addiction Bureaucracy

Abstract: Romancing Opiates – Pharmacological Lies and the Addiction Bureaucracy was written by psychiatrist Theodore Dalrymple. It is based on his 14 years of experience as a British prison doctor as well as his work in a large UK general hospital serving a lower socioeconomic region of the country. In his own words, Dr. Dalrymple “...seeks to expose the willful misconceptions, the lies and evasions, of the past two hundred years with regard to opiate addiction.”(pg 8) In his self-admitted “personal exorcism or catharsis” he attempts to persuade the reader that addiction to opiates is not an illness at all but a moral or spiritual problem, and that the current system of treatment not only has been ineffective, but also has made the problem worse. The book is eloquently written, weaving elements of history, literature, pharmacology, and personal philosophy into a plausible-sounding argument that may convince the reader with no prior knowledge of addiction. However, other than having “very briefly run a drug addiction clinic in a famous university town” and supervising the opiate withdrawal of a number of patients under his care, the author does not otherwise claim any hands-on experience in the ongoing management of patients with addiction disorders.(pg 3) Dalrymple appears to take his narrow experience with a severely affected segment of the opiate-addicted population and generalize it to everyone suffering from opiate addiction. The vast majority of professionals today view addiction as a “biopsychosocialspiritual” illness occurring in biogenetically vulnerable people. The optimum treatment therefore should address all of these areas. One key element in treatment and recovery is for the addicted person to take responsibility for his/her behaviors. This is an essential principle of all self-help and/or 12-step recovery programs. In many ways, addiction has a number of similarities to type 2 diabetes. Both have a biogenetic predisposition. No person sets out in life wanting to develop diabetes just as no one grows up wanting to be an addict. If the predisposed individual never tries a psychoactive chemical, he/she is much less likely to develop addiction. If the predisposed individual eats properly and exercises regularly, then he/she is much less likely to manifest diabetes. However, once either person manifests the illness, then each has a primary role in changing his/her behavior to reduce life consequences. In spite of the author's claim that too much is being spent on the “addiction bureaucracy,” the amount of money spent per victim by most Western governments to treat this common and costly affliction continues to be woefully inadequate. This is more likely the reason that some programs for opiate addiction may focus only on opioid agonist therapy (OAT) using methadone or buprenorphine. No professional practicing addiction medicine today is naive enough to believe that providing OAT is a cure for the problem of opiate addiction. It is simply an attempt at harm reduction for a condition that has a 2% to 5% success rate at 1 year for abstinence-based treatments. It is an attempt to reduce the high social cost of law enforcement and the medical care of consequences, such as HIV, hepatitis B and C, and others. There are many patients who benefit from OAT and are able to reconstruct and get on with their lives. Sadly there are also many who are not ready to change their drug-using lifestyle and simply attempt to “play the game of poker,” as Dr. Dalrymple puts it, with the prescribing physician.(pg 24) The author builds a reasoned case to dispute the public's belief that withdrawal from opiates is a severely risky and painful undertaking.(pg 20) He correctly points out that opiate withdrawal is a time-limited process and much less medically risky than withdrawal from alcohol, barbiturates, and benzodiazepines. However, clinical experience in both addiction and pain management demonstrates that the severity of withdrawal is a very individual process and not necessarily related to the dosage or duration of drug use. In a psychosocially vulnerable patient, avoiding withdrawal can be a powerful stimulus to continue seeking and using drugs. Dr. Dalrymple challenges the “romancing” of opiate abuse by analyzing the writings of famous opioid-using authors such as Samuel Taylor Coleridge, Thomas DeQuincy, and William S. Burroughs, who claimed that opiates expanded their consciousness. However, most often, regular opioid abusers are more interested in chemically escaping their life predicaments than using the drugs to think on a higher plain. In his final section on potential solutions to the problem of opiate addiction, the author has strong opinions against the legalization of opiates as a crime-reduction strategy.(pg 110) He further proposes “closure of all clinics claiming to treat drug addicts” and writes: “This would put an end to the harmful pretense that addicts are ill and in need of treatment.” He further proposes that “doctors should treat addicts only for the serious physical complications of drug addiction. ” Other than these 2 opinions, Dr. Dalrymple offers no other practical solutions to the problem. Theodore Dalrymple's extreme view of opiate addiction and treatment is definitely not in keeping with mainstream thinking in the treatment of these afflictions. Nonetheless, Romancing Opiates will be of interest to those working in the field of addiction – particularly those treating patients with opiate addiction.

A case study using a patient satisfaction survey to improve the delivery and effectiveness of drug addiction treatment services: marketing implications and organizational impact.

Abstract: Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services.

Patient-provider e-mail communication as an adjunctive tool in addiction medicine.

Abstract: Frequent electronic mail communication between patients and their addiction specialist can be utilized as an adjunct in the treatment of alcohol or substance dependency. Selected patients benefit from mandatory daily electronic mail communications with their provider through enhanced accountability, frequent self-assessment, deterrents to isolation, and a sense of continuous access to care. Participants have found the experience easy and enjoyable and all have maintained continuous sobriety. We present our experience using this modality as a series of illustrative case reports and a discussion of the implications of using electronic mail with patients in addiction medicine.

Addiction Medicine and Addiction Psychiatry in America: The Impact of Physicians in Recovery on the Medical Treatment of Addiction

Abstract: Man at work has been praised as peaceful, and so have forests, but a detailed study of either will show that conflict can occur without being either swift or bloody.-WILLIAM J. GOODE (1960:902)The term addiction medicine is often used by newspapers, magazines, and other media to refer to a broad body of medical and scientific knowledge on substance abuse in which nearly all physicians might have some expertise (e.g., Denizet-Lewis 2006; Katz 2005). Although widespread, this understanding is not accurate. In actuality, two distinct medical disciplines treat addiction in the United States: one is called addiction medicine and the other is called addiction psychiatry.Addiction medicine was born in 1954 out of "the alcoholism movement" of the mid-twentieth century. The alcoholism movement was a new approach to alcohol addiction that was systematized in the 1940s and 1950s by Alcoholics Anonymous, the Research Council on Problems of Alcohol, the Yale section of Alcohol Studies, and the National Council on Alcoholism (Johnson 1973; Levine 1978; Page 1988; Page 1997; Roizen 1991; seeley 1962; White 1998; Wilkerson 1966). Addiction medicine grew rapidly between the 1960s and 1980s, largely due to the efforts of physicians from New York, California, and Georgia to "re-medicalize" addiction. As this article will show, during these formative years, many physicians working in addiction medicine were themselves recovering from alcoholism or drug abuse. They were among the ranks of thousands of former alcoholics and drug addicts who permanently reoriented their careers toward addiction treatment (White 2000a). Today, the field's leading organization, the American Society of Addiction Medicine (ASAM, pronounced A-SAM), has about 3,000 members. According to reliable estimates from prominent ASAM officers and former officials, approximately one-third of ASAM's membership is in recovery from addiction.1Addiction psychiatry comes from very different roots. This discipline formally originated in 1985 when a small, influential group of psychiatrists founded their own organization of addiction specialists. The psychiatrists, believing that they could treat addiction far more effectively than addiction medicine physicians, especially those in recovery, were unnerved that "addictionologists" had displaced them at the forefront of treatment. In 1991, addiction psychiatrists successfully persuaded the American Board of Medical Specialties that they possessed a body of specialized knowledge on addiction. This won them subspecialty recognition from the American Board of Psychiatry and Neurology, giving addiction psychiatry substantial status and power over the field of addiction treatment. Addiction medicine, in contrast, holds no specialty or subspecialty status in organized medicine.This article stems from a larger sociological and historical research project analyzing the development and current training and treatment practices of addiction medicine and addiction psychiatry. In the course of conducting pilot interviews for that research, the topic of physicians in recovery who provide addiction treatment surfaced, and did so in nearly 24 subsequent interviews without my initiating the subject. (see the appendix for a complete discussion of data collection and analysis.) Accordingly, this article argues that physicians in recovery have played a key role in creating the field of addiction medicine in America, and that the development of addiction medicine inadvertently contributed to the formation of addiction psychiatry. It suggests that questions about the type of knowledge which physicians in recovery call on to treat addiction are central to an ongoing professional conflict between addiction medicine and addiction psychiatry over what Goode (1960) labels the "right to responsibility" for the medical treatment of addiction.The first reformed physicians to treat addictionPhysicians who were reformed drunkards first became prominent in the late nineteenth and early twentieth centuries (White 2000b). …

Evaluating Addiction Treatment Outcomes

Abstract: Addiction treatment is an effective clinical intervention, though employers and other purchasers of healthcare services or health insurance frequently have doubts about this fact. Public officials and even physicians are often pessimistic about the ability of addiction treatment to generate worthwhile results. A major reason for pessimism has to do with the way people look at addiction and its treatment, not appreciating that it is a chronic disease, and that most evaluations of chronic disease interventions assess postintervention clinical status while the treatment condition is still in place—not 3 or 12 months after active treatment has been discontinued. Evaluating addiction and its treatment appropriately, contemporary, evidence-based, multidimensional addiction treatment will not be found wanting as an effective intervention for one of our nation's major public health challenges.

Addiction treatment: science and policy for the twenty-first century.

Abstract: Addiction to alcohol, tobacco, and other drugs is one of the major public health issues of our time In the United States, one in five deaths is the result of addictive drug use This innovative book critically examines drug addiction treatment in the United States It explores specific challenges (scientific, medical, social, and legal) to reaching the goal that treatment for drug addiction should be as accessible as treatments for diseases of the heart, liver, and lungs that often result from the use of addictive drugs These essays, written by leaders in addiction science, medicine, and health policy, present diverse and often opposing points of view to foster thought and discussion The book consists of three parts Part I examines the emerging science and theories that underlie the development of specific models for treating addiction to illicit opioids and stimulants, alcohol, tobacco, and prescription drugs Part II explores the complications raised by the diversity of those with addictions, ranging from pregnant women who use intravenous drugs, young men who abuse methamphetamines, youths who smoke cigarettes, to adults who abuse alcohol to those who smoke marijuana or abuse prescription drugs Part III provides a detailed analysis of health care, social, and policy issues that challenge our views about addiction and its treatment It addresses controversial topics such as whether addiction should be considered a disease or a behavior, whether addiction should be handled as a criminal offense or treated as a public health problem, and whether stigmatizing addiction is helpful or not Throughout the book, compelling examples of addiction art explore the human side of addiction through the lens of visual artists' stunning insights into addiction and recovery Addiction Treatment provides a solid foundation for understanding addiction as a treatable illness and for establishing a framework for effective treatment in the twenty-first century

Addiction is a Mental Disorder, Best Managed in a (Public) Mental Health Setting—But Our System is Failing Us

Abstract: Charl Els, MBChB, FCPsych, MMedPsych1 (Can J Psychiatry 2007;52:167-169) For centuries, mental illness was viewed as an invasion by evil spirits that had to be exorcised. Later practices dictated sending the afflicted away to asylums, and eventually the custodial model gave way to a trend of deinstitutionalization. Despite its deficits, this translated into an increased potential for societal involvement and interaction that changed the mental health landscape. In the context of addiction, the last few decades have yielded a body of evidence confirming the formerly disavowed disease of addiction as a group of bona fide mental disorders. Although this disease concept is endorsed by most contemporary psychiatrists, many health care systems' models have not successfully escaped the "moral management archetype" holding addiction hostage. What does this mean, and how does this affect patient care? There are more questions than answers, and easy solutions are evasive, making the challenges at a systems level at least as intractable as the problem of addiction itself. Addictionology, or the study of addictions, has emerged as a distinct and useful subspecialty,1 and despite the multifaceted presentation of addictive disorders, it is described with remarkable similarity in major global mental health taxonomy systems.2 Additionally, although the diagnoses in this category have achieved sufficient construct validity and internal consistency of criteria on a systems level, addiction is often not recognized as such and is neglected when public health policy and fiscal priorities are determined. Could patients be falling through the cracks as a result of our health care system's failure to adequately endorse addiction as a chronic, relapsing mental disorder? Is it possible that some policy-makers' views of addiction as a personal choice (or a social phenomenon responsible for undesirable behavior, crime, and immorality) have not been replaced by a more enlightened stance? The prevailing policies separating addiction from mainstream psychiatry certainly do not speak to the contrary. Addiction may, at last, be coming out of the shadows, but it is certainly not in from the cold. Although addiction is a complex disease involving physiological, psychological, genetic, behavioural, and environmental factors, it is fundamentally a disease of the brain,3-5 and like many other chronic mental disorders, it is amenable to treatment. In what amounts to a historical anomaly, the mental health community was (and in many jurisdictions still is) disenfranchised as the primary and rightful custodian for the treatment of this disease. Would it be considered a leap of faith to suggest that the treatment of this chronic mental disorder could be best directed by the discipline dedicated to the study and treatment of other chronic disorders of the brain? Addiction is the most common psychiatric disorder and the most prevalent comorbid condition in individuals with other mental illnesses. It costs the Canadian economy an estimated $40 billion annually,6 which is greater than the economic impact of all other mental illnesses combined. Further, for several plausible reasons, the prevalence and costs of addiction are increasing and have possibly not yet reached a plateau. Nevertheless, despite the devastating economic impact of addictions, a dire need for solutions, and the confusing panoply of available (but not necessarily effective) treatment options, most addicted individuals remain untreated. In treatment-seeking cases, the health care system often finds itself ill-equipped, yet compelled to deal with complications arising from addictions. In a system where there is no universal expectation to meet evidence-based standards, many addicted individuals seeking treatment fail to find an appropriately matched modality. In this diluted and fragmented system, so-called addicts may find themselves stigmatized, disenfranchised, homeless, impoverished, destitute, or drifting in and out of psychiatric facilities, the criminal justice system, emergency departments, and faith-based settings. …

Chronic Addiction and Recovery Management: Implications for Clinical Practice.

Abstract: In 2001, Dr. Lonnie Shavelson published Hooked, a provocative study of the lives of five individuals whose addictions propelled them through multiple episodes of addiction treatment and encounters with a host of other community institutions. Shavelson’s ethnography of addiction was in part an expose of a treatment system that failed to comprehend and respond to the chronic and complex nature of addiction and recovery. This article summarizes the empirical evidence that addiction is for many a chronic condition, identifies risk factors for such chronicity, highlights the consequences of treating chronic addiction in the context of an acute care model, and notes the emergence of sustained recovery management models as well as the clinical implications of such models.

One size does not fit all: observations on the "phenomenon of two-thirds" in clinical psychopharmacology.

Abstract: 1 Woodbridge Hospital and Institute of Mental Health, Singapore 2 Department of Psychiatry, Singapore General Hospital, Singapore 3 Department of Addiction Medicine, Woodbridge Hospital and Institute of Mental Health, Singapore Address for Correspondence: Dr Ng Beng Yeong, Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore 169608. Email: ng.beng.yeong@sgh.com.sg Introduction In clinical medicine the diagnosis is often established according to a known aetiology or an elucidated pathophysiology. A recent trend in management is to follow certain “evidence-based medicine” guidelines, which are often established by some consensus and then recommended as the “gold standard”.1 Psychiatric diagnoses, and the definition of a psychiatric disorder, are generally based on a cluster of symptoms or a syndrome, with a duration criterion as well. With advances in biological psychiatry, psychopharmacology and neuron-imaging, the pathophysiology of mental illness is often understood in terms of neuroanatomy, neuronal circuitry, neurotransmitters, and receptor systems.2 Eisenberg3 has succinctly summarised the aspirations of the biological school of psychiatry: “For every twisted thought there is a twisted molecule”. Certain symptoms tend to coexist in different illnesses. For example, a set of symptoms that reflects a diminution in mental and motor activity occurs in schizophrenia, affective disorders, basal ganglia diseases, and subcortical dementias.4 However, no individual mental symptom is confined to a single disease, and virtually all the common symptoms of mental illness can occur in any of the currently recognised major mental illnesses.4 Also, it is the norm that symptoms cluster in a similar manner in different diseases. Liddle4 opined that this clustering reveals something of the inner structure of the human mind, and of the organisation of the supporting brain. In psychopharmacology, a specific class of psychotropic drugs is developed for a specific category of mental disorder. However, the brain structures and their functioning maybe altered by the individual’s psychic experience, physical needs, and environmental stimuli. As a rule, beneficial outcomes can be achieved only by simultaneously reducing symptoms and promoting the capacity of the individual to adapt to the exigencies of his or her life.5

Intergenerational Addiction and Child Abuse: Treatment and Policy Approaches

Abstract: This single case study reviews the therapeutic needs of a DCFS mother who was raised in an abusive, alcoholic home environment and was in need of addiction treatment to reunify with her own children. Issues of abuse and neglect, addiction, roles and patterns of adult children from alcoholic homes, and addiction treatment are examined. The Stone Center’s relational model of women’s development is utilized to understand the gender-related therapeutic needs of mothers who have lost their children to DCFS and are also addicted to alcohol and drugs. Implications for practice are discussed, including specific needs of women in addiction treatment, coordination of services between child welfare and treatment facilities, and child welfare policy with reference to the mandates of the Adoption and Safe Families Act (ASFA) and its impact on reunification for families with addiction.