DOCSLIB.ORG

Comorbidity: Which We Have Insufficient Information, So It Remains a Research Priority for Addiction and Other Mental Illnesses NIDA

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comorbidity: Which We Have Insufficient Information, So It Remains a Research Priority for Addiction and Other Mental Illnesses NIDA Is there a relationship between childhood ADHD and later drug abuse? See page 2. from the director: Comorbidity is a topic that our stakeholders––patients, family members, health care professionals, and others–– frequently ask about. It is also a topic about Comorbidity: which we have insufficient information, so it remains a research priority for Addiction and Other Mental Illnesses NIDA. This Research Report provides information on the state of the science in this area. Although a variety of diseases commonly co-occur with drug abuse and addiction (e.g., HIV, hepatitis C, cancer, cardiovascular disease), this report focuses only on the comorbidity of drug use disorders and other mental illnesses.* To help explain this comorbidity, we need to first recognize that drug addiction is a mental illness. It is a complex brain disease characterized by compulsive, at times uncontrollable drug craving, seeking, and use despite devastating consequences— behaviors that stem from drug-induced changes in brain structure and function. These changes occur in some of the same brain areas that are disrupted in other mental disorders, such as depression, anxiety, or schizophrenia. It is therefore not surprising that population surveys show a high rate of co-occurrence, or comorbidity, between drug addiction and other mental illnesses. While we cannot always prove a What Is connection or causality, we do know that certain mental disorders are established Comorbidity? risk factors for subsequent drug abuse— and vice versa. It is often difficult to disentangle the hen two disorders or illnesses occur in the same overlapping symptoms of drug addiction and other mental illnesses, making person, simultaneously or sequentially, they diagnosis and treatment complex. Correct diagnosis is critical to ensuring appropriate are described as comorbid. Comorbidity also and effective treatment. Ignorance of or W implies interactions between the illnesses that affect the failure to treat a comorbid disorder can jeopardize a patient’s chance of recovery. course and prognosis of both. We hope that our enhanced understanding continued inside of the common genetic, environmental, and neural bases of these disorders—and the dissemination of this information—will lead to improved treatments for comorbidity and *Since the focus of this report is on comorbid drug use disorders and will diminish the social stigma that makes other mental illnesses, the terms “mental illness” and “mental disorders” patients reluctant to seek the treatment will refer here to disorders other than substance use disorders, such as they need. depression, schizophrenia, anxiety, and mania. The terms “dual diagnosis,” Nora D. Volkow, M.D. “mentally ill chemical abuser,” and “co-occurrence” are also used to refer to Director drug use disorders that are comorbid with other mental illnesses. National Institute on Drug Abuse Research Report Series Comorbidity Is Drug Addiction How Common a Mental Illness? Are Comorbid Yes, because addiction changes Drug Use and the brain in fundamental ways, Other Mental disturbing a person’s normal Disorders? hierarchy of needs and desires and substituting new priorities Many people who regularly Childhood ADHD connected with procuring and abuse drugs are also diagnosed and Later Drug using the drug. The resulting with mental disorders and vice compulsive behaviors that versa. The high prevalence of this Problems override the ability to control comorbidity has been documented impulses despite the consequences in multiple national population Numerous studies have are similar to hallmarks of other surveys since the 1980s. Data documented an increased risk for mental illnesses. show that persons diagnosed drug use disorders in youth with with mood or anxiety disorders untreated ADHD, although some In fact, the DSM, which is the suggest that only a subset of definitive resource of diagnostic are about twice as likely to suffer these individuals are vulnerable: criteria for all mental disorders, also from a drug use disorder those with comorbid conduct (abuse or dependence) compared disorders. Given this linkage, it is with respondents in general. The important to determine whether Addiction same is true for those diagnosed effective treatment of ADHD changes the with an antisocial syndrome, could prevent subsequent drug brain, disturbing such as antisocial personality abuse and associated behavioral or conduct disorder. Similarly, problems. Treatment of childhood the normal persons diagnosed with drug ADHD with stimulant medications hierarchy of disorders are roughly twice as such as methylphenidate or needs and amphetamine reduces the likely to suffer also from mood impulsive behavior, fidgeting, desires. and anxiety disorders (see page 3, and inability to concentrate “Overlapping Conditions— Shared that characterize ADHD. Yet, Vulnerability”). some physicians and parents includes criteria for drug use Gender is also a factor in the have expressed concern that disorders, distinguishing between specific patterns of observed treating childhood ADHD with two types: drug abuse and drug comorbidities. For example, stimulants might increase a child’s Drug dependence the overall rates of abuse and vulnerability to drug abuse later in dependence. dependence for most drugs tend life. Recent reviews of long-term is synonymous with addiction. studies of children with ADHD By comparison, the criteria for to be higher among males than who were treated with stimulant drug abuse hinge on the harmful females. Further, males are more medications (e.g., Adderal, Ritalin, consequences of repeated use but likely to suffer from antisocial Concerta) found no evidence for do not include the compulsive personality disorder, while women this increase. However, most of use, tolerance (i.e., needing higher have higher rates of mood and these studies have methodological doses to achieve the same effect), anxiety disorders, all of which are limitations, including small sample or withdrawal (i.e., symptoms that risk factors for substance abuse. sizes and nonrandomized study designs, indicating that more occur when use is stopped) that research is needed, particularly can be signs of addiction. with adolescents. 2 NIDA Research Report Series Overlapping Conditions—Shared Vulnerability High Prevalence of Drug Abuse and Dependence Why Do Drug Use Among Individuals With Mood and Anxiety Disorders Disorders Often Co- 25 Occur With Other All respondents 20 Any mood disorder Mental Illnesses? Any anxiety disorder The high prevalence of comorbidity 15 between drug use disorders and other mental illnesses does not mean that one 10 caused the other, even if one appeared Because mood disorders first. In fact, establishing causality or 5 increase vulnerability to directionality is difficult for several drug abuse and addiction, reasons. Diagnosis of a mental disorder the diagnosis and 0% may not occur until symptoms have Any Drug Opioids Amphetamines Cocaine Marijuana treatment of the mood disorder can reduce the progressed to a specified level (per Higher Prevalence of Mental Disorders risk of subsequent drug DSM); however, subclinical symptoms Among Patients With Drug Use Disorders use. Because the inverse may also prompt drug use, and may also be true, the imperfect recollections of when drug use 50 diagnosis and treatment or abuse started can create confusion as of drug use disorders to which came first. Still, three scenarios All respondents may reduce the risk of 40 Any drug use disorder developing other mental deserve consideration: illnesses and, if they do 1. Drugs of abuse can cause abusers to occur, lessen their severity 30 experience one or more symptoms of or make them more another mental illness. The increased amenable to effective risk of psychosis in some marijuana 20 treatment. Finally, because more than 40 abusers has been offered as evidence percent of the cigarettes for this possibility. 10 smoked in this country are smoked by individuals 2. Mental illnesses can lead to drug with a psychiatric disorder, abuse. Individuals with overt, mild, 0% Mood Disorders Anxiety Disorders such as major depressive or even subclinical mental disorders disorder, alcoholism, post- may abuse drugs as a form of self- traumatic stress disorder medication. For example, the use (PTSD), schizophrenia, or Higher Prevalence of Smoking Among of tobacco products by patients Patients With Mental Disorders bipolar disorder, smoking by patients with mental with schizophrenia is believed to 80 illness contributes lessen the symptoms of the disease Current smokers greatly to their increased and improve cognition (see page 70 morbidity and mortality. 4, “Smoking and Schizophrenia: 60 Self-Medication or Shared Brain 50 Circuitry?”). 40 3. Both drug use disorders and 30 other mental illnesses are caused by overlapping factors such as 20 underlying brain deficits, genetic 10 vulnerabilities, and/or early exposure 0% to stress or trauma. No Mental Major Alcohol Post-Traumatic Drug Bipolar Illness Depression Abuse or Stress Abuse or Disorder Dependence Disorder Dependence All three scenarios probably contribute, in varying degrees, to how and whether specific comorbidities manifest Data in top two graphs reprinted from the National Epidemiologic Survey on Alcohol and Related Conditions (Conway et al., 2006). Data in bottom graph from the 1989 U.S. National Health Interview Survey (Lasser et al., 2000). themselves. NIDA Research Report Series 3 Common Factors Overlapping Genetic Vulnera- bilities. A particularly active
Load more

Recommended publications
  • NIDA Monograph 172, Table of Contents
    Treatment of Drug-Dependent Individuals With Comorbid Mental Disorders Editors: Lisa Simon Onken, Ph.D. Jack D. Blaine, M.D. Sander Genser, M.D., M.P.H. and Arthur MacNeill Horton, Jr., Ed.D. NIDA Research Monograph 172 1997 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on Drug Abuse Division of Clinical Research 5600 Fishers Lane Rockville, MD 20857 i ACKNOWLEDGMENT This monograph is based on the papers from a technical review on "Comorbid Mental and Addictive Disorders: Treatment and HIV-Related Issues" held on September 27-28, 1994. The review meeting was sponsored by the National Institute on Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder's permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in this volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein.
    [Show full text]
  • Substance Abuse and Dependence
    9 Substance Abuse and Dependence CHAPTER CHAPTER OUTLINE CLASSIFICATION OF SUBSTANCE-RELATED THEORETICAL PERSPECTIVES 310–316 Residential Approaches DISORDERS 291–296 Biological Perspectives Psychodynamic Approaches Substance Abuse and Dependence Learning Perspectives Behavioral Approaches Addiction and Other Forms of Compulsive Cognitive Perspectives Relapse-Prevention Training Behavior Psychodynamic Perspectives SUMMING UP 325–326 Racial and Ethnic Differences in Substance Sociocultural Perspectives Use Disorders TREATMENT OF SUBSTANCE ABUSE Pathways to Drug Dependence AND DEPENDENCE 316–325 DRUGS OF ABUSE 296–310 Biological Approaches Depressants Culturally Sensitive Treatment Stimulants of Alcoholism Hallucinogens Nonprofessional Support Groups TRUTH or FICTION T❑ F❑ Heroin accounts for more deaths “Nothing and Nobody Comes Before than any other drug. (p. 291) T❑ F❑ You cannot be psychologically My Coke” dependent on a drug without also being She had just caught me with cocaine again after I had managed to convince her that physically dependent on it. (p. 295) I hadn’t used in over a month. Of course I had been tooting (snorting) almost every T❑ F❑ More teenagers and young adults die day, but I had managed to cover my tracks a little better than usual. So she said to from alcohol-related motor vehicle accidents me that I was going to have to make a choice—either cocaine or her. Before she than from any other cause. (p. 297) finished the sentence, I knew what was coming, so I told her to think carefully about what she was going to say. It was clear to me that there wasn’t a choice. I love my T❑ F❑ It is safe to let someone who has wife, but I’m not going to choose anything over cocaine.
    [Show full text]
  • Dual Diagnosis and Integrated Treatment of Mental Illnesses and Substance Use Disorders
    Dual Diagnosis and Integrated Treatment of Mental Illnesses and Substance Use Disorders 1919 University Avenue West, Suite 400, St. Paul, MN 55104 Tel. 651-645-2948 or 888-NAMIHELPS www.namihelps.org What are dual diagnosis services? Dual diagnosis services are treatments for people who suffer from co-occurring disorders -- mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems -- focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time. Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment. How often do people with severe mental illnesses also experience a co-occurring substance abuse problem? There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA): • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse. • Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.
    [Show full text]
  • Dual Diagnosis: SHOW YOU CARE
    or supportive housing. Some people find How to Get Help therapy to be a helpful part of maintaining No insurance? Call the NAMI Southern their sobriety. This can include individual Arizona office to help guide you to access DUAL therapy (e.g., cognitive behavioral therapy) mental health services. as well as self-help groups such as Alcoholics Anonymous, Narcotics If you have dual diagnosis: SHOW YOU CARE. DIAGNOSIS Anonymous or Smart Recovery. Seek medical care through a psychiatrist WEAR A SILVER RIBBON. Certain medications to help maintain and/or your primary care physician. sobriety have been safely tested in multiple studies. For alcoholism, available Find the right combination of treatment Help break down the barriers to FIND HELP. medications include disulfiram (Antabuse), that works for you which may include treatment and support. acamprosate (Campral) and naltrexone medication, therapy, support groups, Help reduce stigma —talk about it! FIND HOPE. (Revia). For opiate abuse, available etc. *Sometimes people must try medications include naltrexone (Revia, several different treatments or combinations of treatment before they Vivitrol), methadone and buprenorphine Mental illness affects 1 in 5 people. We (Subutex, Suboxone). Given how find the one that works for them. provide resources and support to all those complicated these choices may be, it is Take NAMI’s Peer-to-Peer course affected by mental illness. necessary for any individuals with dual and/or join the NAMI Connection diagnosis and their loved ones to discuss support group. NAMI SOUTHERN ARIZONA DEPENDS ON YOU. medication management strategies with their doctors. LEARN about your illness. The more you THERE ARE MANY WAYS TO HELP.
    [Show full text]
  • Guidelines for Treating Dissociative Identity Disorder in Adults, Third
    This article was downloaded by: [208.78.151.82] On: 21 October 2011, At: 09:20 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Trauma & Dissociation Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjtd20 Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision International Society for the Study of Trauma and Dissociation Available online: 03 Mar 2011 To cite this article: International Society for the Study of Trauma and Dissociation (2011): Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187 To link to this article: http://dx.doi.org/10.1080/15299732.2011.537247 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.
    [Show full text]
  • Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders
    J Autism Dev Disord (2006) 36:849–861 DOI 10.1007/s10803-006-0123-0 ORIGINAL PAPER Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders Ovsanna T. Leyfer Æ Susan E. Folstein Æ Susan Bacalman Æ Naomi O. Davis Æ Elena Dinh Æ Jubel Morgan Æ Helen Tager-Flusberg Æ Janet E. Lainhart Published online: 15 July 2006 Ó Springer Science+Business Media, Inc. 2006 Abstract The Kiddie Schedule for Affective Disorders sample demonstrated a high prevalence of specific phobia, and Schizophrenia was modified for use in children and obsessive compulsive disorder, and ADHD. The rates of adolescents with autism by developing additional screening psychiatric disorder in autism are high and are associated questions and coding options that reflect the presentation of with functional impairment. psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview- Keywords Psychopathology Æ Autism Æ Psychiatric Present and Lifetime Version (ACI-PL), was piloted and interview Æ Comorbidity frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The Children with autism frequently have problematic emo- tional reactions and behaviors along with the features that O. T. Leyfer Department of Psychological and Brain Sciences, University define autism. Disturbances of emotion, attention, activity, of Louisville, Louisville, KY, USA and thought, and associated behavioral problems occur in children with autism of all ages (Lainhart, 1999). It is not S. E. Folstein yet known how often these additional difficulties are due to Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA comorbid psychiatric disorders.
    [Show full text]
  • The Impact of Paradoxical Comorbidities on Risk-Adjusted
    MMRR 2011: Volume 1 (3) Medicare & Medicaid Research Review 2011: Volume 1, Number 3 A publication of the Centers for Medicare & Medicaid Services, Center for Strategic Planning Mary S. Vaughan-Sarrazin,1,2 Xin Lu,2 and Peter Cram 2 ¹Iowa City Veterans Administration Medical Center Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) ²University of Iowa Carver College of Medicine, Department of Internal Medicine Division of General Internal Medicine The impact of paradoxical comorbidities on risk- adjusted mortality of Medicare beneficiaries with cardiovascular disease Abstract Background: Persistent uncertainty remains regarding assessments of patient comorbidity based on administrative data for mortality risk adjustment. Some models include comorbid conditions that are associated with improved mortality while other models exclude these so-called paradoxical conditions. The impact of these conditions on patient risk assessments is unknown. Objective: To examine trends in the prevalence of conditions with a paradoxical (protective) relationship with mortality, and the impact of including these conditions on assessments of risk adjusted mortality. Methods: Patients age 65 and older admitted for acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery during 1994 through 2005 were identified in Medicare Part A files. Comorbid conditions defined using a common algorithm were categorized as having a paradoxical or non-paradoxical relationship with 30-day mortality, based upon regression coefficients in multivariable logistic regression models. Results: For AMI, the proportion of patients with one or more paradoxical condition and one or more non-paradoxical condition increased by 24% and 3% respectively between 1994 and 2005. The odds of death for patients with one-or-more paradoxical comorbidities, relative to patients with no paradoxical comorbidity, declined from 0.69 to 0.54 over the study period.
    [Show full text]
  • An Empirical Examination of Six Myths About Dissociative Identity Disorder Bethany L
    PERSPECTIVES Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder Bethany L. Brand, PhD, Vedat Sar, MD, Pam Stavropoulos, PhD, Christa Krüger, MB BCh, MMed (Psych), MD, Marilyn Korzekwa, MD, Alfonso Martínez-Taboas, PhD, and Warwick Middleton, MB BS, FRANZCP, MD Abstract: Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diag- nosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside.
    [Show full text]
  • Substance Use Disorders (SUD) Begin in Childhood Or Adolescence (Kandel, 1992)
    PSYCHIATRY TELEHEALTH, LIAISON & CONSULTS (PSYCH TLC) Substance Related Disorders in Children and Adolescents Written and initially reviewed, 11/2011: Zaid Malik, M.D. Deepmala Deepmala, M.D Jody Brown, M.D. Laurence Miller, M.D. Reviewed and updated, 03/04/2014: Deepmala Deepmala, M.D. Work submitted by Contract # 4600016732 from the Division of Medical Services, Arkansas Department of Human Services 1 | P a g e Department of Human Services Psych TLC Phone Numbers: 501-526-7425 or 1-866-273-3835 The free Child Psychiatry Telemedicine, Liaison & Consult (Psych TLC) service is available for: Consultation on psychiatric medication related issues including: . Advice on initial management for your patient . Titration of psychiatric medications . Side effects of psychiatric medications . Combination of psychiatric medications with other medications Consultation regarding children with mental health related issues Psychiatric evaluations in special cases via tele-video Educational opportunities This service is free to all Arkansas physicians caring for children. Telephone consults are made within 15 minutes of placing the call and can be accomplished while the child and/or parent are still in the office. Arkansas Division of Behavioral Health Services (DBHS): (501) 686-9465 http://humanservices.arkansas.gov/dbhs/Pages/default.aspx 2 | P a g e Substance Related Disorders in Children and Adolescents ______________________________________________________ Table of Contents 1. Epidemiology 2. Symptomatology 3. Diagnostic Criteria -- Highlights of Changes from DSM IV to DSM 5 3.1 Substance Use Disorder 3.2 Substance Induced Disorder 3.2.1 Substance Withdrawal 3.2.2 Substance Intoxication 3.2.3 Substance/Medication-Induced Mental Disorders 4. Etiology, Risk Factors and Protective Factors 4.1 Etiology 4.2 Risk Factors and Protective Factors 5.
    [Show full text]
  • Treatment of Patients with Substance Use Disorders Second Edition
    PRACTICE GUIDELINE FOR THE Treatment of Patients With Substance Use Disorders Second Edition WORK GROUP ON SUBSTANCE USE DISORDERS Herbert D. Kleber, M.D., Chair Roger D. Weiss, M.D., Vice-Chair Raymond F. Anton Jr., M.D. To n y P. G e o r ge , M .D . Shelly F. Greenfield, M.D., M.P.H. Thomas R. Kosten, M.D. Charles P. O’Brien, M.D., Ph.D. Bruce J. Rounsaville, M.D. Eric C. Strain, M.D. Douglas M. Ziedonis, M.D. Grace Hennessy, M.D. (Consultant) Hilary Smith Connery, M.D., Ph.D. (Consultant) This practice guideline was approved in December 2005 and published in August 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available in the Psychiatric Practice section of the APA web site at www.psych.org. 1 Copyright 2010, American Psychiatric Association. APA makes this practice guideline freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this guideline may be reproduced except as permitted under Sections 107 and 108 of U.S. Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at http://www.appi.org/CustomerService/Pages/Permissions.aspx. AMERICAN PSYCHIATRIC ASSOCIATION STEERING COMMITTEE ON PRACTICE GUIDELINES John S. McIntyre, M.D., Chair Sara C. Charles, M.D., Vice-Chair Daniel J. Anzia, M.D. Ian A. Cook, M.D. Molly T. Finnerty, M.D. Bradley R. Johnson, M.D. James E. Nininger, M.D. Paul Summergrad, M.D. Sherwyn M.
    [Show full text]
  • Medical Comorbidities in Autism Spectrum Disorders
    TA-ESPA-ATP PAPER 2014 1st draft_Layout 1 21/07/2014 19:21 Page 1 Medical Comorbidities in Autism Spectrum Disorders A Primer for Health Care Professionals and Policy Makers Second Edition: July 2014 Prepared by: l Treating Autism l ESPA Research l Autism Treatment Plus TA-ESPA-ATP PAPER 2014 1st draft_Layout 1 21/07/2014 19:21 Page 2 Treating Autism , a charity run entirely by volunteers, provides information and support to families and individuals affected by autism with the aim of improving their quality of life. Registered Charity: www.treatingautism.co.uk No. 1113628, Limited Company Registered in England: No. 5594787. ESPA Research is a not-for-profit subsidiary of ESPA (Education and Services for People with Autism) dedicated to undertaking high-quality research into autism and related conditions all for the public benefit. www.espa-research.org.uk ESPA Research Ltd. Company registration: 6862992. ESPA Registered Charity No. 1037868 | Company No. 2909953 Autism Treatment Plus, dedicated to helping individuals with autism reach optimal health and learning, provides access to diagnostic, medical and behavioural services. www.autismtreatment.org.uk. Limited company registered in England: No. 08623707. © Treating Autism Publications, 2014 Second edition, published July 2014. (First edition published March 2013). All rights reserved. Reproduction of this report, in its entirety and unaltered, by photocopying or electronic means for noncommercial purposes is permitted. Otherwise, no part of this report may be reproduced, adapted, stored in a retrieval system or transmitted by any means, electronic, mechanical, photocopying, or otherwise without the prior written permission of Treating Autism Publications. ISBN: 978-0-9575787-2-2 A pdf version of this publication is available from the Treating Autism website www.treatingautism.co.uk.
    [Show full text]
  • International Standards for the Treatment of Drug Use Disorders — Draft for Field Testing
    E/CN.7/2016/CRP.4 11 March 2016 English only Commission on Narcotic Drugs Fifty-ninth session Vienna, 14-22 March 2016 Item 9 of the provisional agenda* Preparations for the special session of the General Assembly on the world drug problem to be held in 2016 International Standards for the Treatment of Drug Use Disorders — Draft for Field Testing The International Standards for the Treatment of Drug Use Disorders (Standards) were prepared by UNODC and WHO to support Member States in the development and expansion of treatment services that offer effective and ethical treatment. The goal of such treatment is to reverse the negative impact that persisting drug use disorders have on the individual and to help them achieve as full recovery from the disorder as possible and to become a productive member of their society. The Standards were developed in the framework of the UNODC-WHO Programme on Drug Dependence Treatment and Care and are built on existing publications. They provide United Nations Member States with a practical and comprehensive technical tool that will help to guide policy development; plan, organize and manage drug treatment services within and beyond the health system; develop the capacity of human resources; and evaluate service and system level interventions. The Standards will be made available to the Commission for its consideration at its fifty- ninth session. __________________ * E/CN.7/2016/1. V.16-01463 (E) *1601463* INTERNATIONAL STANDARDS FOR THE TREATMENT OF DRUG USE DISORDERS DRAFT FOR FIELD TESTING March 2016 Acknowledgements The United Nations Office on Drugs and Crime (UNODC) would like to acknowledge the following for their invaluable contribution to the process of publication of these standards: The group of international experts for providing the relevant scientific evidence, technical advice and developing the main draft of the standards, including (in alphabetical order): Dr.
    [Show full text]