Addiction medicine

About: Addiction medicine is a research topic. Over the lifetime, 1070 publications have been published within this topic receiving 23685 citations.

Reflections of an Academic Clinical Researcher on the past 40 Years of Addiction Development

Abstract: This paper reflects on three areas of addiction: prescription drug abuse, perinatal addiction, and the clinical fields of addiction medicine and addiction psychiatry. The concerns about the abuse and misuse of prescription drugs date back over a century with numerous laws passed to address these problems. Despite these laws, there has been increasing concern over the past decade about the increases in the nonmedical use and abuse of prescription drugs. This begs the question of whether the passing of laws addressing the supply side of the problem is the correct approach. Abuse of licit and illicit drugs by pregnant women creates concern because of the effects of drugs and alcohol on the fetus and future development of the child. Most of the studies have addressed newborn development without adequate studies of the effects of the drugs and withdrawal on pregnancy and the fetus. In addition, studies of long-term effects on the development of the child are needed. The only way to adequately address these imp...

Internet Addiction Treatment: The Therapists’ View

Abstract: Literature on Internet addiction treatment is scarce, and there is little consensus among experts as to the most effective treatment intervention. To fill this gap in knowledge, this chapter aims to explore how Internet addiction therapy experts experience the presenting problem of Internet addiction in psychotherapy. A total of 20 psychotherapists from six different countries (i.e., Germany, United Kingdom, United States of America, Canada, Austria, and Switzerland) were interviewed regarding their individual experience of treating patients suffering from Internet addiction. Data were analysed using Interpretative Phenomenological Analysis. Two superordinate themes (“risk” and “addiction”) were identified during the data analysis.

Accès aux médicaments contenant des substances psychoactives placées sous contrôle international. Recommandations en faveur d’une terminologie neutre, précise et respectueuse

Abstract: The European Pain Federation EFIC, the International Association for Hospice and Palliative Care, International Doctors for Healthier Drug Policies, the Swiss Romandy College for Addiction Medicine, the Swiss Society of Addiction Medicine, and the World Federation for the Treatment of Opioid Dependence called on medical journals to ensure that authors always use terminology that is neutral, precise, and respectful in relation to the use of psychoactive substances. It has been shown that language can propagate stigma, and that stigma can prevent people from seeking help and influence the effectiveness of social and public-health policies. The focus of using appropriate terminology should extend to all patients who need controlled medicines, avoiding negative wording. A narrow focus on a few terms and medical communication only should be avoided. The appropriateness of terms is not absolute and indeed varies between cultures and regions and over time. For this reason, it is important that communities establish their own consensus of what is “neutral”, “precise”, and “respectful”. We identified 23 problematic terms (most of them we suggest avoiding) and their possible alternatives. The use of appropriate language improves scientific quality of articles and increases chances that patients will receive the best treatment and that government policies on psychoactive substance policies will be rational.

Focus: Addiction: Addiction

Abstract: In the United States, 21.6 million individuals older than 12 are diagnosed with abuse or dependence to drugs and/or alcohol each year [1]. Consequently, direct and indirect costs to society stemming from addiction total more than $700 billion annually in the United States alone [1]. Addiction to drugs and alcohol has long been recognized as a mental health disorder, appearing in some form in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since its inception in 1952 [2]. However, only recently have non-drug addictions (e.g., food and behavioral addictions) begun to gain increased acceptance as potentially classifiable addictions, as emphasized by the American Psychiatric Association’s (APA) reclassification of pathological gambling into the Substance-Related and Addictive Disorders category in the recent DSM-5 [3]. Only a minority of individuals who drink alcohol, smoke, or use drugs develop pathological use. The same can be said of individuals who eat, gamble, play online video games, or engage in other behaviors that might become addictive. Even individuals who engage in heavy drinking or who are obese may not meet suggested criteria for pathological alcohol use or eating behavior. Furthermore, in lesser amounts, using alcohol, using drugs, or engaging in behaviors with addiction-like potential may provide benefits. Thus, a spectrum of use exists, begging the question of where to draw the line between heavy use and addictive use. Clinical definitions distinguish heavy from pathological use by a continuation of use despite adverse consequences and a presence of distress, but in practice, this distinction is often difficult to make. In exploring substances and behaviors with addictive potential, it is critical to obtain a multifaceted, unbiased understanding of how the substances and behaviors both benefit and harm individuals and society in order to best discover policies and treatments to address addiction. In this issue of the Yale Journal of Biology and Medicine, the editors present articles on a variety of topics related to addiction in order to provide an informative, well-rounded depiction of drug and alcohol use, maladaptive behaviors, and potential policies and treatments related to addiction. The editors have selected articles that highlight areas within addiction that are emerging in importance. Original research presented by Serafini and Stewart demonstrates the importance of perceptions of sibling’s alcohol use on the likelihood of drinking alcohol in young adults. Rutherford and colleagues also present original research, investigating the differences in brain structure between substance-using and non-substance-using mothers and how maternal substance use relates to general motivation. Often people have the mindset that any drug prescribed by a doctor in a medical setting is safe from addiction and abuse, but clinicians know otherwise. In this issue, Tetrault and Butner provide an overview of the increasing rates of non-medical prescription opioid use and the accompanying growing dangers of addiction and overdose. Hawk and colleagues review strategies aimed at reducing fatalities from opioid overdose, which are becoming more common in the United States from increased prescription opioid use. Weaver also describes misuse and abuse of prescription sedatives such as benzodiazepines. Additionally, drugs such as marijuana have been demonstrated to have potential medical uses despite being illegal to prescribe by physicians in most U.S. states. Hall reviews the policy changes that have been made with the increased adoption of medical marijuana in the United States. Sun and colleagues review the effectiveness and safety of the use of marijuana for treatment of glaucoma. Understanding the benefits of drugs of abuse is important for policy and prevention targeted toward reducing addiction. Smoking tobacco and obesity are the two leading causes of preventable death in the United States [4]. Annamalai reviews the importance of encouraging patients with serious mental illness to attempt smoking cessation, an important topic since the rates of smoking among people with serious mental illness remain much higher than the general population. Wickham reviews the biology of how menthol interacts with nicotine, which is an imperative line of research to study given the growing market for flavored electronic cigarettes. Rupprecht reviews the intersection and interrelation of the two health hazards of obesity and smoking. Additionally, Meule chronicles the history of food addiction research. An enhanced understanding of non-drug addictions is emerging in importance as the APA promotes researching more behavioral addictions for inclusion in the next edition of the DSM. In this vein, Szabo details the importance of coming to a common consensus about what constitutes a behavioral addiction as he discusses the particular case of exercise addiction. Xu and colleagues review the research on video game addiction and detail the associated risk of addiction when developing video games to treat amblyopia. Voss and colleagues describe a case report of pornography use-associated Internet Gaming Disorder, a behavioral addiction garnering increasing attention. Treatment development is another area of active investigation in the field of addiction, and several relevant articles are contained in this issue. Xu and colleagues describe a novel technique using transcranial direct current stimulation (tDCS) to increase activity in both sides of the prefrontal cortex, and the authors discuss the potential for treating addiction using tDCS intervention. Melemis offers his perspective on maintaining recovery from addiction using five rules to avoid relapse. Heshmat describes recovery from addiction from a behavioral economics perspective, offering his insight into how best to achieve abstinence. Additionally, Robertson-Boersma and colleagues discuss the potential for peer intervention to reduce binge alcohol drinking in college students. It is crucial for society to continue to increase its understanding of addiction to drugs, alcohol, and behaviors in order to establish improved behavioral and pharmacological treatments for addiction. Additionally, continued unbiased discussion about addiction will allow society to develop and implement effective public policy that balances both the detrimental and beneficial effects of drugs, alcohol, and addictive behaviors. Lastly, additional research into non-drug addictions is essential in order that a valid and reliable diagnostic system can be created to better identify and treat addictions to food, exercise, video games, etc. in a clinical setting. The articles presented in this issue aim to advance society one step further in its knowledge and understanding of addiction.

Book Review: Substance Abuse: Treating Alcohol and Drug Use Disorders in Psychotherapy Practice: Doing What WorksSubstance Abuse Treating Alcohol and Drug Use Disorders in Psychotherapy Practice: Doing What WorksWashtonArnold M, ZwebenJoan E.New York (NY): Guilford Press; 2006. 312 p. US$35.00.

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. …