Showing papers on "Addiction medicine published in 2011"

The case for considering quality of life in addiction research and clinical practice.

Abstract: Substance use disorders are increasingly viewed as chronic conditions, and addiction treatment services are beginning to adopt models that were developed to address other chronic conditions. These models address the impact of disease and services on the patient's overall well-being. From this perspective, treatment for addiction aims for the broad goal of recovery, which is defined as abstinence plus improved quality of life. However, the addiction field has come late to the chronic disease perspective, and the concept of quality of life in addiction is relatively undeveloped. This article reviews the evidence for the relevance of quality of life in substance use disorder treatment and recovery and discusses the importance of incorporating quality-of-life indices into research and services.

CBT-IA: The First Treatment Model for Internet Addiction

Abstract: Research has identified Internet addiction as a new clinical disorder that causes relational, occupational, and social problems. Cognitive behavioral therapy (CBT) has been suggested as the treatment of choice for Internet addiction, and addiction recovery in general has used CBT as part of treatment planning. This article outlines cognitive behavioral therapy-Internet addiction (CBT-IA), a uniquely designed model for treating Internet addiction applying CBT with harm reduction therapy (HRT). CBT-IA uses a three-phase approach. In the first phase, behavior modification is used to gradually decrease the amount of time the addict spends online. In the second phase, cognitive therapy is used to address denial that is often present among Internet addicts and to combat the rationalizations that justify excessive online use. The third phase applies HRT to identify and treat coexisting issues involved in the development of compulsive Internet use. As the first model of its kind, it can be used both on an outpatient and inpatient basis to deal with this emergent client population. Keywords: cognitive behavioral therapy; Internet addiction; recovery; treatment; harm reduction therapy Studies on Internet addiction originated in the United States. More recently, studies have documented Internet addiction in a growing number of countries such as Italy (Ferraro, Caci, D'Amico, & Di Blasi, 2007), Pakistan (Suhail & Bargees, 2006), and the Czech Republic (Simkova & Cincera, 2004). Reports also indicate that Internet addiction has become a serious public health concern in China (BBC News, 2005), Korea (Hur, 2006), and Taiwan (Lee, 2007). About 10% of China's more than 30 million Internet gamers were said to be addicted. To battle what has been called an epidemic by some reports, Chinese authorities regularly shut down Internet cafes, many illegally operated, in crackdowns that also include huge fines for their operators. The Chinese government has also instituted laws to shut down the number of hours adolescents can play online games and opened the first inpatient treatment center for Internet addiction in Beijing. In the United States, Internet addiction has also been considered for classification in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-V; Block, 2008), and it is expected to be included in the appendix for the upcoming edition. It is difficult to estimate how widespread the problem is. Given the popularity of the Internet, detecting and diagnosing Internet addiction is often difficult as its legitimate business and personal use mask addictive behavior (Young, 2010). However, in a nationwide study conducted by a team from Stanford University's School of Medicine, it was estimated that nearly one in eight Americans exhibit at least one possible sign of problematic Internet use (Aboujaoude, Koran, Gamel, Large, & Serpe, 2006). Researchers have likened Internet addiction to impulse-control disorders on Axis I in DSM-IV (e.g., Aboujaoude et al., 2006; Beard & Wolf, 2001; Block, 2008; Shapira et al., 2003; Young, 1998) and have used various forms of DSM-IV based criteria to define Internet addiction. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment for impulse control disorders such as intermittent explosive disorder, pathological gambling, and trichotillomania (Hucker, 2004). CBT has also been effective in treating substance abuse, emotional disorders, and eating disorders (Beck, 1979; Beck, Wright, Newman, & Liese, 1993). Researchers have suggested using CBT to treat Internet addiction (e.g., Greenfield, 1999; Hansen, 2002; Orzack, 1999), given the compulsive nature and similarity to other disorders successfully treated with CBT. However, Internet addiction has been noted to be different from other compulsive syndromes given the daily and necessary use of the Internet and technology in general. Therefore, this article outlines cognitive behavioral therapy-Internet addiction (CBT-IA), a uniquely designed model for treating Internet addiction, applying CBT with harm reduction therapy (HRT). …

The effect of psychiatric symptoms on the internet addiction disorder in Isfahan's University students.

Abstract: BACKGROUND: Internet addiction disorder is an interdisciplinary phenomenon and it has been studied from different viewpoints in terms of v arious sciences such as medicine, computer, sociology, law, ethics, and psychology. The aim of this study was to determine the association of psychiatric symptoms with Internet addiction while controlling for the effects of age, gender, marital status, and educational levels. It is hypothesized, that high levels of Internet addiction are associated with psychiatric symptoms and are specially correlated with obsessive-compulsive disorder symptoms. METHODS: In a cross-sectional study, a total number of 250 students from Isfahan’s universities were randomly selected. Subjects complet ed the demographic questionnaire, the Young Diagnostic Questionnaire (YDQ) and the Symptom Checklist-90-Revision (SCL-90-R). Data was analyzed using the multiple logistic regression method. RESULTS: There was an association between psychiatric symptoms such as somatization, sensitivity, depression, anxiety, aggression, phobias , and psychosis with exception of paranoia; and diagnosis of Internet addiction controlling for age, sex, education level, marital status, and type of universities. CONCLUSIONS: A great percentage of youths in the population suffer from the adverse effects of Internet addiction. It is necessary for psychiatri sts and psychologists to be aware of the mental problems caused by Internet addiction.

Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction

Abstract: Objectives:Opioid addiction affects over 2 million patients in the United States. The advent of buprenorphine and the passage of the Drug Addiction Treatment Act in 2000 have revolutionized the opioid treatment delivery system by granting physicians the ability to administer office-based opioid trea

Integrating Addiction Medicine Into Graduate Medical Education in Primary Care: The Time Has Come

Abstract: Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is insufficient training for physicians about substance use disorders. To address this deficit, the Betty Ford Institute convened a meeting of experts who developed the following 5 recommendations focused on improving training in substance abuse in primary care residency programs in internal medicine and family medicine: 1) integrating substance abuse competencies into training, 2) assigning substance abuse teaching the same priority as teaching about other chronic diseases, 3) enhancing faculty development, 4) creating addiction medicine divisions or programs in academic medical centers, and 5) making substance abuse screening and management routine care in new models of primary care practice. This enhanced primary care residency training should represent a major step forward in improving patient care.

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: Implications for Pain Physicians

Abstract: 1Department of Family Medicine, University of Toronto; Addiction Medicine Service, Department of Family Medicine, St Joseph’s Health Centre; 2Department of Medicine, Division of Physiatry, Institute of Medical Science, University of Toronto; Comprehensive Pain Program, Toronto Western Hospital; ACTION Ontario, Centre for the Study of Pain, Toronto; 3Department of Psychiatry, McMaster University, Hamilton; Canadian Memorial Chiropractic College, Toronto, Ontario Correspondence: Dr Meldon Kahan, Department of Family Medicine, East Wing, 30 The Queensway, St Joseph’s Health Centre, Toronto, Ontario M6R 1B5. Telephone 416-530-6860, fax 416-530-6106, e-mail kahanm@stjoe.on.ca Chronic pain is a serious public health concern, causing widespread suffering and disability, and increased health care costs (1). Potent opioids have become a mainstay of chronic pain treatment, and both the number of patients taking opioids and the mean dose per patient have increased substantially in North America. Unfortunately, this has been accompanied by marked increases in opioid-related deaths, diversion, misuse and addiction, generating concern among the public and the medical profession. For a guideline to be credible, it should be based on a comprehensive search of controlled trials and other studies, supplemented by the perspectives of experienced clinicians and opinion leaders. It should address questions important to public health and provide practical guidance to clinicians. These goals have been achieved in the recently published “Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain” (2). Under the umbrella of the Federation of Medical Regulatory Authorities of Canada, the National Opioid Use Guideline Group was created in 2008 to collaborate on guideline development and implementation. A core research group was formed, which conducted a systematic review of the effectiveness of opioids for chronic noncancer pain (CNCP), as well as focused reviews on topics such as medical complications of opioids and use of opioids in specific populations. The core group wrote an initial draft of the guideline. A 49-member panel that included physicians from family medicine, physiatry, neurology and addiction medicine, and various other health care providers, reviewed the draft and provided feedback through a structured approach. All major regions of Canada were represented on the panel, which included members of national organizations such as the Canadian Pain Society. The panel achieved consensus on 24 recommendations. Some highlights of the guideline are provided below.

Framing Nicotine Addiction as a “Disease of the Brain”: Social and Ethical Consequences†

Abstract: In November 2010, the Director of the National Institutes of Health (NIH), Francis Collins, announced the creation of a taskforce to help move all substance use, abuse, and addiction research programs within the NIH into a single, new institute (Collins, 2010). This transition would force a merger of the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the drug-related research portfolios from other institutes such as the National Cancer Institute (NCI) (Seffrin et al., 2010). Supporters justify the new institute’s creation by highlighting an emerging body of scientific findings: recent research in neuroscience suggests that a single mechanism underlies compulsive behavior and addiction, regardless of the particular substance or drug of abuse. Similar brain reward pathways are thought to be involved in the development and maintenance of addiction, raising the possibility of common risk factors and the hope for novel prevention and treatment strategies across substances. In addition, supporters argue that many would be better served by a single institute combining all substance use, including patients with comorbid drug use, as well as the general population, which would benefit from comprehensive early prevention efforts (Scientific Management Review Board, 2010). Collins stated that this new institute “makes scientific sense and would enhance NIH’s efforts to address the substance abuse and addiction problems that take such a terrible toll on our society” (Collins, 2010). However, the merger remains contentious; others express concern that the merger will result in less funding for drug or substance-specific research portfolios focused on prevention, as well as decreased support for psychological and social research. One concern is that an overly reductionist vision of addiction is fueling the merger in ways that may narrow the research focus, minimizing approaches that situate addiction within a complex biopsychosocial context. One coalition of tobacco prevention groups complained: “We believe that the proposed reorganization could also narrow the focus of tobacco-related research to issues related to addiction when such research, however significant, is only one of several areas in which innovation research is necessary to expand the evidence base” (Seffrin et al., 2010:2–3). Similarly, Caryn Lerman, President of the Society for Research on Nicotine and Tobacco, advised NIH director Francis Collins that if “tobacco use research is to be moved from other NIH institutes to a new Institute, retain tobacco policy and product research within NCI, consistent with the relevance of this subset of the portfolio to medical consequences of drug use” (Lerman, 2010:3, emphasis in original). In other words, there is a concern that addiction’s etiology will be reduced to biology alone, to a “disease of the brain.” No decisions have been announced regarding this possible merger. Framing addiction as a disease of the brain with common mechanisms is one driving force behind the proposed merger, which is of special concern since NIDA claims that it alone “supports more than 85 percent of the world’s research on the health aspects of drug abuse and addiction” (National Institute on Drug Abuse, 2004). Although NIDA funds prevention and environmental influences on drug initiation, maintenance, and cessation, the bulk of NIDA research funding ($519.497 million) goes to “Basic and Clinical Neuroscience,” which includes work to “expand the understanding of the neurobiological, genetic/epigenetic, and behavioral factors underlying drug abuse and addiction” (National Institute on Drug Abuse, 2011). Another $116.017 million goes to “Pharmacotherapies and Medical Consequences” research, which is responsible for “medications development aimed at helping people recover from drug abuse and addiction and sustain abstinence” (National Institute on Drug Abuse, 2011). By contrast, research in “Epidemiology, Services and Prevention Research,” which seeks to “promote integrated approaches to understand and address the interactions between individuals and environments that contribute to the continuum of drug abuse-related problems,” receives less funding ($260.465 million). Cutting-edge research that seeks to “elucidate the nature of the addictive process; to determine the potential use of new therapies for substance abuse, both pharmacological and psychosocial; and to decipher the long-term consequences of drug abuse on brain development, maturation, function, and structure, and on other organ systems,” funded through the intramural research program,” receives $90.368 million (National Institute on Drug Abuse, 2011).NIAAA similarly privileges biomedical research (Midanik, 2004). Clearly, though prevention and gene- and brain-environment interaction is important to these funding institutions, genetic and neuroscience research are prioritized, suggesting the discursive power of reductionist, biological views of addiction. Important social consequences arise from the way neuroscience and genetic research is subtly, and at times not so subtly, constructing a new understanding of addiction as a disease of the brain or as a “genetic” or biological disorder. In this article, we use nicotine addiction as a case study through which to understand the changing nature of our perceptions of addiction and to anticipate how new frameworks will be integrated into existing public health and clinical programs at the federal, state, and local levels. Indeed, the issues and concerns we raise are not limited to the study of one phenomenon, nicotine addiction, but are relevant to a range of complex behaviors that involve substance use for which researchers seek to locate genetic underpinnings. Tobacco serves as an illustrative case because the medicalization of smoking/tobacco addiction has occurred more recently than for other substances, for example, alcoholism. It is also an arena where both social programs (e.g., clean air laws and higher taxes) and pharmaceutical interventions (e.g., nicotine replacement therapies) have been successful. In this article we draw on in-depth interviews with 86 experts in tobacco control, nicotine addiction research, or smoking cessation to examine how genetic research on addiction (and addiction more broadly) shapes the meaning ascribed to smoking and thus affects the scope and structure of tobacco control policy. This article is organized around four key questions raised by critical analyses of this body of research. First, will genetic research change how we understand addiction? We argue that most stakeholders hold a medicalized view of addiction, though a cultural shift that would locate addiction solely within the body, especially with regard to initiation, has not occurred. However, biology is widely understood to be a factor in the strength and speed with which one becomes addicted after initiation. Second, will increased focus on addiction as a disease of the brain lead to unrealistic expectations for treatment? Our data suggests that this is not likely, but for teenagers, it may reinforce expectations that quitting smoking is not difficult. Third, will it change the way people understand cessation, cessation options, and their personal responsibility for or ability to quit smoking? We argue that this research will change what people understand to be the most effective cessation techniques, with increased emphasis on pharmaceuticals and decreased emphasis on “willpower” and modification of behaviors and environments. Finally, will it increase or decrease stigmatization of smoking? We predict that it is unlikely this research will either increase or decrease smoking stigma, but that individuals will utilize the research to buttress their existing view of stigmatization and smoking. Because of the complex nature of smoking and addiction, we join the voices of those from a wide variety of disciplines studying addiction who are calling for an interdisciplinary understanding of addiction as a biosocial or biocultural phenomenon (Acker, 2010; Courtwright, 2010; Keane and Hamill, 2010; Kushner, 2010; Vrecko, 2010; Windle, 2010).

Addiction Neuroethics: The Promises and Perils of Neuroscience Research on Addiction

Abstract: Drug addiction is a significant problem facing most societies It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al, 2007) Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005) Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al, 2000) Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms I refer to this as Addiction Neuroethics The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research This thesis falls into three parts First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided This includes the neuroanatomy of addiction (eg the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (eg motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (eg theft to fund drug habit) Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment Addiction is a highly stigmatised condition This can significantly impact upon the way in which neuroscience research is understood and applied Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment Addicted individuals should be treated as any other individual suffering from a medical condition The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation

Addictions in pain clinics and pain treatment.

Abstract: A great deal of fear exists in the world of pain management on the part of both healthcare professionals and some patients where issues of abuse, misuse, and addiction are concerned. While it might be easy to consider all pain patients as "drug seekers" or addicts, the reality remains that most pain patients are genuine; we therefore must retain pain management efforts for the many, while being aware and cognizant of the few who have problems such as addiction. To begin to separate these entities, definitions and hallmarks of addiction are explored along with discussion of screening tools that can be employed to help identify problematic patients. In addition, the concepts of dependence and tolerance are defined and separated from old notions of addiction. Finally, issues related to engaging in a multidisciplinary approach are discussed along with caveats regarding prescribing to patients who have histories or ongoing issues of addiction.

Comorbid pain and opioid addiction: psychosocial and pharmacological treatments.

Abstract: Treating comorbid pain (nonmalignant) and opioid addiction is a complex endeavor that requires cooperation of multi-modal treatment teams incorporating pharmacological, psychological, and social components. There are multiple barriers for patients, mental health practitioners, and physical health practitioners to provide complete treatment for this difficult treatment population. In this article, we will review which treatments have been empirically validated in this treatment population, where further research is required, and considerations for potential “best approaches” to use for patient treatment while waiting for empirically validated treatment data. We will also discuss some complementary and alternative medicine approaches that have empirical validity in treating either pain or addiction individually, though empirical validity for the treatment of comorbid pain and addiction has not been established.

Developing a Competence-Based Addiction Medicine Curriculum in Indonesia: The Training Needs Assessment

Abstract: Indonesia has one of the fastest growing, injecting drugs user-driven, human immunodeficiency virus (HIV) epidemics in Asia. Coverage of needle and syringe programs (NSPs), opioid substitution therapy (OST), and antiretroviral treatment (ART) is increasing, but is still low, whereas professional training in addiction medicine is not yet established. Urgent development and scaling-up of professional capacity in comprehensive, evidence-based addiction medicine is needed. In this article the results of the first step is presented, being the training needs assessment (TNA) and the process of further developing a national evidence- and competence-based addiction medicine curriculum in Indonesia.

The Master in Addiction Medicine Program in The Netherlands

Abstract: Since 2007 there is a full-time, 2-year professional training in addiction medicine in the Netherlands The aim of this article is to describe in detail the development and present status of the Dutch Master in Addiction Medicine (MiAM) program In this competency-based professional training, theoretical courses are integrated with learning in clinical practice under guidance of an experienced clinical teacher The theoretical courses consist of evidence-based medicine, communication and basic psychotherapeutic skills, neurobiology of addiction, addiction medicine, addiction and psychiatry, and public health The 7 main competencies are made ready for operation in the personal education plan and are evaluated by different styles of examination

The evolution of addiction medicine as a medical specialty.

Abstract: The medicalization of addiction has greatly improved identification, early intervention, and referral to appropriate treatment.

Understanding Addiction Behaviours: Theoretical and Clinical Practice in Health and Social Care

Abstract: PART I ADDICTION AND SOCIETY Introduction Addiction and Society Perspectives on Addiction PART II PHARMACOLOGICAL AND NON-PHARMACOLOGICAL ADDICTIONS Alcohol Opiates Psychostimulants Cannabis Hallucinogens & Other Psychoactive Substances Synthetic Drugs: Smart or Eco Drugs & Spice Tobacco and Nicotine Eating Disorders Gambling Addiction Internet Addiction Sexual Addiction PART III ADDICTION IN CONTEXT Dual Diagnosis: Addiction & Psychiatric Disorders Addiction & Harm Reduction Special Needs & Diversity Service Provisions & Interventions

Chronic disease and recent addiction treatment utilization among alcohol and drug dependent adults

Abstract: Background Chronic medical diseases require regular and longitudinal care and self-management for effective treatment. When chronic diseases include substance use disorders, care and treatment of both the medical and addiction disorders may affect access to care and the ability to focus on both conditions. The objective of this paper is to evaluate the association between the presence of chronic medical disease and recent addiction treatment utilization among adults with substance dependence.

Specialized Training on Addictions for Physicians in the United States

Abstract: In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited “fellowships,” or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training. Information about ADP residency programs has been tabulated, but it is not available for ADM fellowships. The authors conducted a national survey to compile information about the location, structure, curriculum, and other characteristics of active ADM fellowships. Of the 40 accredited ADP residency programs, 7 offered training in addiction to nonpsychiatrists. The authors identified 14 nonaccredited ADM fellowships. In 2009 and 2010, there were approximately 15 nonpsychiatrists in ADP programs and 25 in ADM fellowships. Clinical experiences included inpatient services, outpatient treatment services such as methadone maintenance or buprenorph...

The international certification of addiction medicine: validating clinical knowledge across borders.

Abstract: The experience of the International Society of Addiction Medicine in setting up the first international certification of clinical knowledge is reported. The steps followed and the results of a psychometric analysis of the tests from the first 65 candidates are reported. Lessons learned in the first 5 years and challenges for the future are identified.

Addicted to Food, Hungry for Drugs

Abstract: There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction.

Addiction medicine in Canada: challenges and prospects.

Abstract: In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of "generalists" in family medicine and "sophisticated generalists" among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.

Training in addiction medicine in Australia.

Abstract: Barriers to entering addiction medicine (AM) have led to a persisting workforce shortage To address this problem, the Chapter of Addiction Medicine (AChAM) was formed in 2001 as a subdivision of the Royal Australasian College of Physicians (RACP) Through consultation, AChAM has identified the scope of practice and offered fellowship to suitable established practitioners The Chapter successfully applied to the Australian Government for recognition of AM as a medical specialty, which was finalized in November 2009 Specialist reimbursement item numbers were incorporated into that decision process and commence operating in November 2010 AChAM has designed and implemented a training scheme using a model similar to that of the RACP internal medicine training program This comprises 3 years of basic general medical training post internship followed by 3 years of discipline-specific supervised training The training is broadly based, with experience in both ambulatory care and inpatient care, and in

The potential interest of topiramate in addictions

Abstract: Topiramate is one of the currently most promising compounds in the field of addiction medicine. This paper discusses its potential utility related to a phase model of addiction development, focusing on the assumption that addiction is a continuous process involving different neurobiological pathways, depending on the stage of addiction. A specific emphasis will be made on the development of dysfunctional automatic behaviors in the late stage of addiction and the central role of glutamate and AMPA receptors. The aim is to propose that if too broad an effect of anti-addiction medication is expected (such as anti-craving, anti-relapse and preventive effects), the results might be disappointing. The speculative specific efficacy of topiramate in addiction is described.

Addiction treatment: level of care determination.

Abstract: Substance use disorders occur in 10% to 20% of patients presenting to the primary care physician It is estimated that every fifth patient in a primary care practice has a substance use disorder One of the challenges for the primary care physician after the initial assessment is a referral to the appropriate level of care Substance abuse treatment is now a multibillion dollar industry, and there are a wide variety of options for those with resources Most patients depend on community resources and state- and county-funded programs

Addiction Studies: Exploring Students' Attitudes toward Research in a Graduate Program.

Abstract: The scientist-practitioner (S-P) model or "Boulder model" of training has served as the backbone of counseling psychology doctoral programs in the United States for nearly six decades. Ideally, science-practitioners should be able to apply psychological knowledge to their therapeutic work with clients (Jones, & Mehr, 2007). Research and practice should be synthesized into an integrated way of working which will be expressed in practice by employing a scientific approach (Spengler et al., 1995; Jones, & Mehr, 2007). Gelso and Lent (2000), offered the following synopsis: "Ultimately, ... our science and practice will be enhanced by helping our students learn how scholarly work can be done in the context of practice and practice settings" (p. 135). Over the years, leaders in the field have echoed this call by asserting that further integration of science and practice is needed to strengthen counseling psychology (e.g., Heppner, et al., 1992; Heppner, Casas, Carter, & Stone, 2000; Kahn & Gelso, 1997). Despite the proliferation of research on the S-P model in counseling psychology programs, a lack of investigation in addiction counselor training programs prevails. Part of this may be explained by the sheer numbers of psychology counseling programs as compared to addiction preparatory programs, as well as the underlying structure of addiction counseling. Many addiction counselors are recovering themselves, and historically, the pattern of training and treatment approaches were based on the disease model and 12-step ideology. As such, addiction counselors have been reticent to utilize evidence-based practices and treatments in a formal manner, citing their belief in outdated, empirically flawed methodology. A gap has been noted between what has been shown to be promising in the addiction literature and what is traditionally practiced by clinicians (Hodgson, 1994; Miller, Brown, et al., 1995; Miller & Carroll, 2006; Miller & Hester, 1986). Although research over the past 30 years has helped advance knowledge of substance use disorders and their treatment efficacy, treatment professionals may find it difficult to keep up with such a broad body of literature that encompasses a diverse array of populations, theoretical approaches, study methods, and findings (Kahler, 1995). Previous research indicates that more than of half of addiction counselors are recovering alcoholics/addicts (Koch & Bianco, 2001). The typical addiction counselor is a recovering alcoholic/addict that gains experience through involvement in twelve-step programs and on-the-job training (Koch & Bianco, 2001; Sheehan, 2003). However, recent changes in formal education requirements for certification has prompted paraprofessionals and professionals to enter addiction studies programs (Taleff, 2003), yet many of them are recovering and continue to practice experiential therapy techniques (Walker-Smith et al., 2004). The treatment field is progressively moving from a culture of "recovering" counselors, to ones who are trained in more of a traditional academic and clinical manner. With this shift in culture of training addiction counselors, was the introduction of and conflict with older, more traditional recovering counselor beliefs regarding research-based treatments. Part of this may also be explained by the way in which information in the scientific literature is presented sub-optimally to current clinicians. If they are not trained on how to understand scientific research, understanding how it relates to their clinical practice will be dismissed. For these reasons, it is important to evaluate the recovery status of addiction counselors and students. To date, there is a lack of investigation on the S-P model and attitudes toward research for students in addiction counselor training programs. This study explored attitudes toward research of graduate students enrolled in addiction studies and in community counseling programs at a mid-western University and identified factors that influenced their attitudes. …