An Overview of Outpatient and Inpatient Detoxification
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Methylphenidate Hydrochloride
Application for Inclusion to the 22nd Expert Committee on the Selection and Use of Essential Medicines: METHYLPHENIDATE HYDROCHLORIDE December 7, 2018 Submitted by: Patricia Moscibrodzki, M.P.H., and Craig L. Katz, M.D. The Icahn School of Medicine at Mount Sinai Graduate Program in Public Health New York NY, United States Contact: [email protected] TABLE OF CONTENTS Page 3 Summary Statement Page 4 Focal Point Person in WHO Page 5 Name of Organizations Consulted Page 6 International Nonproprietary Name Page 7 Formulations Proposed for Inclusion Page 8 International Availability Page 10 Listing Requested Page 11 Public Health Relevance Page 13 Treatment Details Page 19 Comparative Effectiveness Page 29 Comparative Safety Page 41 Comparative Cost and Cost-Effectiveness Page 45 Regulatory Status Page 48 Pharmacoepial Standards Page 49 Text for the WHO Model Formulary Page 52 References Page 61 Appendix – Letters of Support 2 1. Summary Statement of the Proposal for Inclusion of Methylphenidate Methylphenidate (MPH), a central nervous system (CNS) stimulant, of the phenethylamine class, is proposed for inclusion in the WHO Model List of Essential Medications (EML) & the Model List of Essential Medications for Children (EMLc) for treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) under ICD-11, 6C9Z mental, behavioral or neurodevelopmental disorder, disruptive behavior or dissocial disorders. To date, the list of essential medications does not include stimulants, which play a critical role in the treatment of psychotic disorders. Methylphenidate is proposed for inclusion on the complimentary list for both children and adults. This application provides a systematic review of the use, efficacy, safety, availability, and cost-effectiveness of methylphenidate compared with other stimulant (first-line) and non-stimulant (second-line) medications. -
Nottinghamshire Primary Care Alcohol Misuse Guidelines
Nottinghamshire Primary Care Alcohol Dependence Guidelines V5.2 Last reviewed: April Review date: August 2021 2022 Title Nottinghamshire Primary Care Alcohol Dependence Guidelines Version 5.2 Lead - Dr Stephen Willott, GP Windmill Practice, Nottingham; Clinical Lead for alcohol misuse, Nottingham Recovery Network and Public Health Department, Nottingham City Council Author / Tanya Behrendt, Senior Pharmacist (Nottingham City Locality), NHS Nottingham and Nottinghamshire CCG Nominated Apollos Clifton-Brown, Operational Manager, Nottingham Recovery Network Dr David Rhinds, Consultant Addictions Psychiatrist, Nottinghamshire Healthcare NHS Foundation Trust Lead Dr Kaanthan Jawahar, ST6 Old Age Psychiatry, Derbyshire Healthcare NHS Foundation Trust Hannah Godden, Mental Health Interface and Efficiencies Pharmacist, Nottinghamshire Healthcare NHS Foundation Trust/ NHS Nottingham and Nottinghamshire CCG Jill Theobald, Interface Efficiencies Pharmacist, NHS Nottingham and Nottinghamshire CCG Approval Date August 2019 Review Date August 2022 Section Contents Page Number i. Summary 2 1. Introduction 4 2. Scope 5 3. Aims of Community Detoxification 5 4. Identifying suitable patients 5 5. Medical risks of community detoxification 6 6. Risk reduction 6 7. Record keeping 7 8. Equipment 7 9. Preparation for home detoxification 7 10. Medication 8 11. Relapse prevention/Follow up 8 12. Reducing alcohol consumption in people with alcohol dependence 9 13. Potentially difficult situations 10 14. References and version control 10 Appendix A Diagnostic Criteria -
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. -
Alcohol Effects on People; 00 Social Responsibility for the Control of the Use of Beverage; and (5) the Social Responsibility for the Treatment of Individuals
DOC- NT RESUME ED 140 180 CG 011 461 TITLE Alcohol Education: Curriculum Guide for Grades 7-12. INSTITUTION New York State Education Dept., Albany. Bureau of Drug Education. PUB DATE 76 NOTE 144p.; For relat d document, see CG 011 462 EERS PRICE MF-$0.83 BC-$7.35 Plus Postage. DESCRIPTORS *Alcohol Education; *Alcoholic Beverages; Class Activities; Curriculum Guides; *Drinking; Drug Education; Health Education; *Learning Activities; Recreational Activities; *Secondary Education; Socially Deviant Behavior; Teaching Guides AB TRACT This curriculum guide is designed as an interdisciplinary resource on alcohol education for teachers of Grades 7-12. tevelopmental traits are discussed, and objectives and learning experiences are presented. The following topics are covered: ro the nature of alcohci;(2) factors influencing the use of alcoholic beverages; (3) alcohol effects on people; 00 social responsibility for the control of the use of beverage; and (5) the social responsibility for the treatment of individuals. A division is made between Grades 7-9 and 10-12, with each set of three grades considered separately. (Author/OLL)' Documents acquired by ERIC include many informal unpublished materials not available from other sources. ERIC makes every effort * * to obtain the best copy available. Nevertheless, items of marginal * * reproducibility are often encountered and this affects the quality * * of the microfiche and hardcopy reproductions ERIC makes available * via the ERIC Document Reproduction Service (EDRS). EDRS is not * responsible for -
XANAX® Alprazolam Tablets, USP
XANAX® alprazolam tablets, USP CIV WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death [see Warnings, Drug Interactions]. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. DESCRIPTION XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system-active compounds. The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-α] [1,4] benzodiazepine. The structural formula is represented to the right: Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH. Each XANAX Tablet, for oral administration, contains 0.25, 0.5, 1 or 2 mg of alprazolam. XANAX Tablets, 2 mg, are multi-scored and may be divided as shown below: 1 Reference ID: 4029640 Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate, silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow No. 6 and the 1 mg tablet contains FD&C Blue No. 2. CLINICAL PHARMACOLOGY Pharmacodynamics CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis. -
Staying Connected Is Important: Virtual Recovery Resources
STAYING CONNECTED IS IMPORTANT: VIRTUAL RECOVERY RESOURCES • Refuge Recovery: Provides online and virtual INTRODUCTION support In an infectious disease outbreak, when social https://www.refugerecovery.org/home distancing and self-quarantine are needed to • Self-Management and Recovery Training limit and control the spread of the disease, (SMART) Recovery: Offers global community continued social connectedness to maintain of mutual-support groups, forums including a recovery is critically important. Virtual chat room and message board resources can and should be used during this https://www.smartrecovery.org/community/ time. Even after a pandemic, virtual support may still exist and still be necessary. • SoberCity: Offers an online support and recovery community This tip sheet describes resources that can be https://www.soberocity.com/ used to virtually support recovery from mental/ substance use disorders as well as other • Sobergrid: Offers an online platform to help resources. anyone get sober and stay sober https://www.sobergrid.com/ • Soberistas: Provides a women-only VIRTUAL RECOVERY PROGRAMS international online recovery community https://soberistas.com/ • Alcoholics Anonymous: Offers online support • Sober Recovery: Provides an online forum for https://aa-intergroup.org/ those in recovery and their friends and family https://www.soberrecovery.com/forums/ • Cocaine Anonymous: Offers online support and services • We Connect Recovery: Provides daily online https://www.ca-online.org/ recovery groups for those with substance use and -
ALCOHOLICS ANONYMOUS 1 Renewed Relevance of Alcoholics Anonymous and Adlerian Psychology
Running head: ALCOHOLICS ANONYMOUS 1 Renewed Relevance of Alcoholics Anonymous and Adlerian Psychology ____________________ Presented to The Faculty of the Adler Graduate School ____________________ In Partial Fulfillment of the Requirement for the Degree of Master of Arts in Adlerian Counseling and Psychotherapy ____________________ By Megan Teale ____________________ Chair: Rashida Fisher MS, LPCC, LADC Reader: Jamie Hedin MA, LPC, LADC ____________________ July 2017 ALCOHOLICS ANONYMOUS 2 Abstract The incorporation of psychological approaches to the Alcoholics Anonymous (AA) is established as a sound way of improving the treatment of alcoholism. Despite mounting evidence of the clinical effectiveness of AA, and its enduring legacy as the prominent approach for healing alcoholism; there remains skepticism regarding its use as a clinical intervention. The literature on the Adlerian orientation has noted the similarity between the two methods, little investigation of the congruence between the two and the implications for an integrated treatment approach has occurred. The purpose of this literature review is to examine how Adlerian theory and positive psychology complement the philosophies and practices of AA. The results support the integration of Adlerian Psychology and AA as ideal for working with clients struggling with alcohol dependence. Furthermore, this literature review suggests that the integration of Adlerian Psychology will enhance and complement the therapeutic dynamics inherent in the AA program, improving the competence of clinicians to treat individuals living the alcoholism and participating in the 12- step programs. Keywords: Adlerian Psychology, Alcoholics Anonymous, Alcoholism, Spirituality ALCOHOLICS ANONYMOUS 3 Dedication To my husband, Eric Teale, for allowing me to turn my dreams into a reality. Thank you for supporting me through my graduate school experience. -
Problems Other Than Alcohol
ALCOHOLICS ANONYMOU S® is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. • The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self-supporting through our own contributions. • A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes. • Our primary purpose is to stay sober and help other alcoholics to achieve sobriety. Copyright © by A.A. Grapevine, Inc.; reprinted with permission Copyright © The A.A. Grapevine, Inc., February 1958 Reprinted with permission by A.A. World Services, Inc. Available from: A.A. General Service Office Box 459, Grand Central Station New York, NY 10163 www.aa.org 100M 03/15 (Ripon) Problems other than alcohol By Bill W. (co-founder, Alcoholics Anonymous) Perhaps there is no suffering more horrible than drug addiction, especially that kind which is pro - duced by morphine, heroin, and other narcotics. Such drugs twist the mind, and the awful pro- cess of withdrawal racks the sufferer’s body. Compared with the addict and his woes, we alcoholics are pikers. Barbiturates, carried to extremes, can be almost as bad. In A.A. we have members who have made great recoveries from both the bottle and the needle. We also have a great many others who were — or still are — victimized by “goofballs” and even by the new tranquilizers. -
Al‑Anon/Alateen
Al-Anon/Alateen Service Manual 2018-2021 Al-Anon and Alateen Digest of Al-Anon and Groups at Work Alateen Policies “Al-Anon and Alateen Groups at Work” The “Digest of Al-Anon and Alateen provides a framework within which each Policies” reflects policy group can develop and grow. statements that grew It offers basic information to out of questions all group members concerning and experiences the group structure and how from the Al-Anon it relates to other groups and fellowship worldwide. Al-Anon as a whole. They are interpretations of our basic guides, the Twelve Traditions and the Twelve Concepts of Service. Al-Anon's Twelve World Concepts of Service Service “Al-Anon’s Twelve Concepts of Service” Handbook deals with the “why” of our service The “World Service Handbook” structure in such explains how Al-Anon is held a way that the together worldwide, how it valuable experience is structured, and how our of the past and the trusted servants can best function lessons drawn from within our structure. that experience can never be forgotten or lost. version two (2) Suggested Meeting Readings This format is printed for your convenience. While not every group chooses to plan its meeting in this way, many find a general outline helpful. See also the pamphlet This Is Al-Anon (P‑32). Alateen Groups at Work Al-Anon and Meeting Opening Most groups open with a moment of silence followed by the Se‑ renity Prayer. The Serenity Prayer Chairperson: Will you join me in a moment of silence, followed by the Serenity Prayer? God grant me the serenity To accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference. -
Who Want Sobriety More Than Anything Else in Life
This booklet is published in the interest of alcoholics who want sobriety more than anything else in life... who have been unable to find release from alcoholism. THE UNHAPPIEST person in the world is the chronic alcoholic who has an insistent yearning to enjoy life as he once knew it, but cannot picture life without alcohol. He has a heart-breaking obsession that by some miracle of control he will be able to do so. AA General Service Office, P.O. Box 1, 10 Toft Green, York YOl 7NJ heart disease cancer alcoholism Yes It does belong on this list Alcoholism is a fatal illness for which there is no known medical cure, and many of its victims are forced to wage a losing battle, not only against the ravages of the illness, but also against the ignorance of a society which largely refuses to regard the alcoholic as a sick person. To many people, the word ‘alcoholic’ means someone who is perverse and weakwilled. “Why on earth doesn’t he control his drinking?” they ask. Those of us who are alcoholics, and who have tried to control our drinking know just how impossible a task that is. This is because alcoholism is an illness. While we stay away from drink, we function much like other people. But if we take any alcohol whatsoever into our systems, something happens both physically and mentally which makes it difficult or impossible for us to stop. We have lost control of our drinking, but... What is this elusive illness called ALCOHOLISM ? The action of alcohol on the alcoholic is similar to the manifestation of an allergy. -
Prescription Medications: Misuse, Abuse, Dependence, and Addiction
Substance Abuse Treatment May 2006 Volume 5 Issue 2 ADVISORYNews for the Treatment Field Prescription Medications: Misuse, Abuse, Dependence, and Addiction How serious are prescription Older adults are particularly vulnerable to misuse and medication use problems? abuse of prescription medications. Persons ages 65 and older make up only 13 percent of the population but Development and increased availability of prescription account for one-third of all medications prescribed,3 drugs have significantly improved treatment of pain, and many of these prescriptions are for psychoactive mental disorders, anxiety, and other conditions. Millions medications with high abuse and addiction liability.4 of Americans use prescription medications safely and Data from the National Survey on Drug Use and Health responsibly. However, increased availability and vari- indicate that nonmedical use of prescription medications ety of medications with psychoactive effects (see Table was the second most common form of substance abuse 1) have contributed to prescription misuse, abuse, among adults older than 55.5 dependence, and addiction. In 2004,1 the number of Americans reporting abuse2 of prescription medications Use of prescription medications in ways other than was higher than the combined total of those reporting prescribed can have a variety of adverse health conse- abuse of cocaine, hallucinogens, inhalants, and heroin. quences, including overdose, toxic reactions, and serious More than 14.5 million persons reported having used drug interactions leading to life-threatening conditions, prescription medications nonmedically within the past such as respiratory depression, hypertension or hypoten- year. Of this 14.5 million, more than 2 million were sion, seizures, cardiovascular collapse, and death.6 between ages 12 and 17. -
The Alcohol Withdrawal Syndrome
Downloaded from jnnp.bmj.com on 4 September 2008 The alcohol withdrawal syndrome A McKeon, M A Frye and Norman Delanty J. Neurol. Neurosurg. Psychiatry 2008;79;854-862; originally published online 6 Nov 2007; doi:10.1136/jnnp.2007.128322 Updated information and services can be found at: http://jnnp.bmj.com/cgi/content/full/79/8/854 These include: References This article cites 115 articles, 38 of which can be accessed free at: http://jnnp.bmj.com/cgi/content/full/79/8/854#BIBL Rapid responses You can respond to this article at: http://jnnp.bmj.com/cgi/eletter-submit/79/8/854 Email alerting Receive free email alerts when new articles cite this article - sign up in the box at service the top right corner of the article Notes To order reprints of this article go to: http://journals.bmj.com/cgi/reprintform To subscribe to Journal of Neurology, Neurosurgery, and Psychiatry go to: http://journals.bmj.com/subscriptions/ Downloaded from jnnp.bmj.com on 4 September 2008 Review The alcohol withdrawal syndrome A McKeon,1 M A Frye,2 Norman Delanty1 1 Department of Neurology and ABSTRACT every 26 hospital bed days being attributable to Clinical Neurosciences, The alcohol withdrawal syndrome (AWS) is a common some degree of alcohol misuse.5 Despite this Beaumont Hospital, Dublin, and management problem in hospital practice for neurologists, Royal College of Surgeons in substantial problem, a survey of NHS general Ireland, Dublin, Ireland; psychiatrists and general physicians alike. Although some hospitals conducted in 2000 and 2003 indicated 2 Department of Psychiatry, patients have mild symptoms and may even be managed that only 12.8% had a dedicated alcohol worker.6 In Mayo Clinic, Rochester, MN, in the outpatient setting, others have more severe addition, few guidelines exist promoting the USA symptoms or a history of adverse outcomes that requires initiation of clear and uniform AWS treatment 7–9 Correspondence to: close inpatient supervision and benzodiazepine therapy.