Stimulant Use Disorder Treatment Guidance
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Smoking Cessation Treatment at Substance Abuse Rehabilitation Programs
SMOKING CEssATION TREATMENT AT SUBSTANCE ABUSE REHABILITATION PROGRAMS Malcolm S. Reid, PhD, New York University School of Medicine, Department of Psychiatry; Jeff Sel- zer, MD, North Shore Long Island Jewish Healthcare System; John Rotrosen, MD, New York University School of Medicine, Department of Psychiatry Cigarette smoking is common among persons with drug and alcohol n Nicotine is a highly use disorders, with prevalence rates of 80-90% among patients in sub- addictive substance stance use disorder treatment programs. Such concurrent smoking may that meets all of produce adverse behavioral and medical problems, and is associated the criteria for drug with greater levels of substance use disorder. dependence. CBehavioral studies indicate that the act of cigarette smoking serves as a cue for drug and alcohol craving, and the active ingredient of cigarettes, nicotine, serves as a primer for drug and alcohol abuse (Sees and Clarke, 1993; Reid et al., 1998). More critically, longitudinal studies have found tobacco use to be the number one cause of preventable death in the United States, and also the single highest contributor to mortality in patients treated for alcoholism (Hurt et al., 1996). Nicotine is a highly addictive substance that meets all of the criteria for drug dependence, and cigarette smoking is an especially effective method for the delivery of nicotine, producing peak brain levels within 15-20 seconds. This rapid drug delivery is one of a number of common properties that cigarette smok- ing shares with hazardous drug and alcohol use, such as the ability to activate the dopamine system in the reward circuitry of the brain. -
Treatment of Stimulant Use Disorders
UW PACC Psychiatry and Addictions Case Conference UW Medicine | Psychiatry and Behavioral Sciences TREATMENT OF STIMULANT USE DISORDERS Matt Iles-Shih, MD Addiction Psychiatry Fellow University Of Washington & VA Puget Sound Health Care System UW PACC ©2017 University of Washington GENERAL DISCLOSURES The University of Washington School of Medicine also gratefully acknowledges receipt of educational grant support for this activity from the Washington State Legislature through the Safety-Net Hospital Assessment, working to expand access to psychiatric services throughout Washington State. UW PACC ©2017 University of Washington SPEAKER DISCLOSURES No conflicts of interest/disclosures UW PACC ©2017 University of Washington OBJECTIVES 1. Brief overview of stimulant-related physiology & epidemiology 2. Recognizing & treating stimulant use disorders: . Diagnosis & management of acute effects (brief) . Psychotherapies (brief) . Pharmacotherapies 3. Special populations – ADHD in stimulant-abusing pts: to Rx, and how? UW PACC ©2017 University of Washington STIMULANTS: What Substances Are We Talking About? Cocaine Amphetamines: – Prescription Meds – Methamphetamine – Multiple other modified amphetamines MDMA (3,4-methylenedioxy-methamphetamine) [Note: mixed stimulant-psychodelic properties, w/↑serotonin > dopamine and abuse >> addiction.] Others: – Cathinones: Khat & Synthetics (e.g., “Bath Salts”) – Piperazine-like substances (various) – Phenylaklylpyrrolidines (various) UW PACC ©2017 University of Washington COMMONALITIES (WHAT MAKES A STIMULANT -
Substance Abuse: the Pharmacy Educator’S Role in Prevention and Recovery
Substance Abuse: The Pharmacy Educator’s Role in Prevention and Recovery Curricular Guidelines for Pharmacy: Substance Abuse and Addictive Disease i Curricular Guidelines for Pharmacy: Substance Abuse and Addictive Disease1,2 BACKGROUND OF THE CURRICULUM DEVELOPMENT PROJECT In 1988, the AACP Special Interest Group (SIG) on Pharmacy Student and Faculty Impairment (renamed Substance Abuse Education and Assistance) undertook the development of curricular guidelines for colleges/schools of pharmacy to facilitate the growth of educational opportunities for student pharmacists. These Curricular Guidelines for Pharmacy Education: Substance Abuse and Addictive Disease were published in 1991 (AJPE. 55:311-16. Winter 1991.) One of the charges of the Special Committee on Substance Abuse and Pharmacy Education was to review and revise the 1991 curricular guidelines. Overall, the didactic and experiential components in the suggested curriculum should prepare the student pharmacist to competently problem-solve issues concerning alcohol and other drug abuse and addictive diseases affecting patients, families, colleagues, themselves, and society. The guidelines provide ten educational goals, while describing four major content areas including: psychosocial aspects of alcohol and other drug use; pharmacology and toxicology of abused substances; identification, intervention, and treatment of people with addictive diseases; and legal/ethical issues. The required curriculum suggested by these guidelines addresses the 1 These guidelines were revised by the AACP Special Committee on Substance Abuse and Pharmacy Education. Members drafting the revised guidelines were Edward M. DeSimone (Creighton University), Julie C. Kissack (Harding University), David M. Scott (North Dakota State University), and Brandon J. Patterson (University of Iowa). Other Committee members were Paul W. Jungnickel, Chair (Auburn University), Lisa A. -
Barriers and Solutions to Addressing Tobacco Dependence in Addiction Treatment Programs
Barriers and Solutions to Addressing Tobacco Dependence in Addiction Treatment Programs Douglas M. Ziedonis, M.D., M.P.H.; Joseph Guydish, Ph.D., M.P.H.; Jill Williams, M.D.; Marc Steinberg, Ph.D.; and Jonathan Foulds, Ph.D. Despite the high prevalence of tobacco use among people with substance use disorders, tobacco dependence is often overlooked in addiction treatment programs. Several studies and a meta-analytic review have concluded that patients who receive tobacco dependence treatment during addiction treatment have better overall substance abuse treatment outcomes compared with those who do not. Barriers that contribute to the lack of attention given to this important problem include staff attitudes about and use of tobacco, lack of adequate staff training to address tobacco use, unfounded fears among treatment staff and administration regarding tobacco policies, and limited tobacco dependence treatment resources. Specific clinical-, program-, and system-level changes are recommended to fully address the problem of tobacco use among alcohol and other drug abuse patients. KEY WORDS: Alcohol and tobacco; alcohol, tobacco, and other drug (ATOD) use, abuse, dependence; addiction care; tobacco dependence; smoking; secondhand smoke; nicotine; nicotine replacement; tobacco dependence screening; tobacco dependence treatment; treatment facility-based prevention; co-treatment; treatment issues; treatment barriers; treatment provider characteristics; treatment staff; staff training; AODD counselor; client counselor interaction; smoking cessation; Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey obacco dependence is one of to the other. The common genetic vul stance use was considered a potential the most common substance use nerability may be located on chromo trigger for the primary addiction. -
Vol. 1, Issue 1
Methamphetamine Topical Brief Series: Vol. 1, Issue 1 What is countries involved in World War II provided amphetamine to soldiers Methamphetamine? for performance enhancement and the drug was used by “actors, artists, Methamphetamine is an addictive, athletes, politicians, and the public stimulant drug that affects the alike.”5 central nervous system. It is typically used in powder or pill form and can By the 1960s, media coverage be ingested orally, snorted, smoked, began drawing simplistic, negative or injected. Methamphetamine is connections between amphetamine known as meth, blue, ice, speed, and and crime, and government officials 1 crystal among other names. The term discussed public safety and drugs amphetamine has been used broadly as a social concern.6 Over-the- to refer to a group of chemicals that counter amphetamines were have similar, stimulating properties available until 1959,7 and by 1970 and methamphetamine is included in all amphetamines were added to 2 this group. According to the National the controlled substances list as Institute on Drug Abuse (NIDA), Schedule II drugs. Schedule II drugs “Methamphetamine differs from required a new prescription with amphetamine in that, at comparable each fill and strict documentation doses, much greater amounts of the by doctors and pharmacists.8 drug get into the brain, making it a The reduction in a legal supply 3 more potent stimulant.” of amphetamine led to increased black-market production and sale From the 1930s to the 1960s, of various types of amphetamine U.S. pharmaceutical -
Cocaine Use Disorder
COCAINE USE DISORDER ABSTRACT Cocaine addiction is a serious public health problem. Millions of Americans regularly use cocaine, and some develop a substance use disorder. Cocaine is generally not ingested, but toxicity and death from gastrointestinal absorption has been known to occur. Medications that have been used as substitution therapy for the treatment of a cocaine use disorder include amphetamine, bupropion, methylphenidate, and modafinil. While pharmacological interventions can be effective, a recent review of pharmacological therapy for cocaine use indicates that psycho-social efforts are more consistent over medication as a treatment option. Introduction Cocaine is an illicit, addictive drug that is widely used. Cocaine addiction is a serious public health problem that burdens the healthcare system and that can be destructive to individual lives. It is impossible to know with certainty the extent of use but data from public health surveys, morbidity and mortality reports, and healthcare facilities show that there are millions of Americans who regularly take cocaine. Cocaine intoxication is a common cause for emergency room visits, and it is one drug that is most often involved in fatal overdoses. Some cocaine users take the drug occasionally and sporadically but as with every illicit drug there is a percentage of people who develop a substance use disorder. Treatment of a cocaine use disorder involves psycho-social interventions, pharmacotherapy, or a combination of the two. 1 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com Pharmacology of Cocaine Cocaine is an alkaloid derived from the Erthroxylum coca plant, a plant that is indigenous to South America and several other parts of the world, and is cultivated elsewhere. -
DIAGNOSIS REFERENCE GUIDE A. Diagnostic Criteria for Substance
ALCOHOL & OTHER DRUG SERVICES DIAGNOSIS REFERENCE GUIDE A. Diagnostic Criteria for Substance Use Disorder See DSM-5 for criteria specific to the drugs identified as primary, secondary or tertiary. P S T (P=Primary, S=Secondary, T=Tertiary) 1. Substance is often taken in larger amounts and/or over a longer period than the patient intended. 2. Persistent attempts or one or more unsuccessful efforts made to cut down or control substance use. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from effects. 4. Craving or strong desire or urge to use the substance 5. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued substance use despite having persistent or recurrent social or interpersonal problem caused or exacerbated by the effects of the substance. 7. Important social, occupational or recreational activities given up or reduced because of substance use. 8. Recurrent substance use in situations in which it is physically hazardous. 9. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. 10. Tolerance, as defined by either of the following: a. Markedly increased amounts of the substance in order to achieve intoxication or desired effect; Which:__________________________________________ b. Markedly diminished effect with continued use of the same amount; Which:___________________________________________ 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance; Which:___________________________________________ b. -
Drug Use and Gender
Drug Use and Gender Tammy L. Anderson, Ph.D. University of lllinois, Chicago, lL GENDER DIFFERENCES IN study-report a greater occurrence ofillicit substance use DRUG USE AND ABUSE among males than among females. Both surveys have consistently documented this pattern over the years. Looking at the world through a "gender lens" began According to the 1997 NHSDA survey, men reported a in most areas of social science during the second wave of higher rate of illicit substance use (any illicit drug) than the women's movement, or the late 1960s through the women, 8.5 percent to 4.5 percent, nearly double. Men 1970s. During this time feminist researchers began report higher rates of cocaine use .9 percent versus .5 questioning science's conclusions by pointing to percent. alcohol use (58 percent versus 45 percent), binge male-oriented biases in research questions, hypotheses, drinking (23 percent versus 8 percent), and heavy drinking and designs. (8.7 percent versus 2.1 percent). The same pattern was Unfortunately, the "gender lens" did not appear in observed in marijuana use (Office of Applied Studies substance use research until the early 1980s. Prior to the [OAS] tee7). 1970s, most studies of alcohol and other drug use were Johnston. O'Malley, and Bachman (1997) the conducted among males. Early studies that included at University of Michigan yearly women suffered from the "add women and stir compile data on the substance use of 8th. 10th, and 12th graders, college students, approach." Females were added to samples, but no and young adults in the MTF study. -
DSM-5 Diagnoses and New ICD-10-CM Codes
DSM-5 DiAgnoses And New ICD-10-CM Codes As Ordered in the DSM-5 Classification DSM-5 Recommended DSM-5 Recommended Disorder ICD-10-CM Code for use ICD-10-CM Code for use through September 30, 2017 beginning October 1, 2017 Avoidant/Restrictive Food Intake Disorder F50.89 F50.82 Alcohol Use Disorder, Mild F10.10 F10.10 Alcohol Use Disorder, Mild, In early or sustained remission F10.10 F10.11 Alcohol Use Disorder, Moderate F10.20 F10.20 Alcohol Use Disorder, Moderate, In early or sustained F10.20 F10.21 remission Alcohol Use Disorder, Severe F10.20 F10.20 Alcohol Use Disorder, Severe, In early or sustained F10.20 F10.21 remission Cannabis Use Disorder, Mild F12.10 F12.10 Cannabis Use Disorder, Mild, In early or sustained F12.10 F12.11 remission Cannabis Use Disorder, Moderate F12.20 F12.20 Cannabis Use Disorder, Moderate, In early or sustained F12.20 F12.21 remission Cannabis Use Disorder, Severe F12.20 F12.20 Cannabis Use Disorder, Severe, In early or sustained F12.20 F12.21 remission Phencyclidine Use Disorder, Mild F16.10 F16.10 Phencyclidine Use Disorder, Mild, In early or sustained F16.10 F16.11 remission Phencyclidine Use Disorder, Moderate F16.20 F16.20 Phencyclidine Use Disorder, Moderate, In early or F16.20 F16.21 sustained remission Phencyclidine Use Disorder, Severe F16.20 F16.20 Phencyclidine Use Disorder, Severe, In early or sustained F16.20 F16.21 remission Other Hallucinogen Use Disorder, Mild F16.10 F16.10 Other Hallucinogen Use Disorder, Mild, In early or F16.10 F16.11 sustained remission Other Hallucinogen Use Disorder, -
Adults with Attention Deficit Hyperactivity Disorder and Substance Use Disorders
ADVISORY Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover Adults With Attention Deficit Hyperactivity Disorder and Substance Use Disorders Attention deficit hyperactivity disorder (ADHD) Which ADHD symptoms are most prominent is one of the most common childhood mental varies with age and circumstance. The hyper- disorders, and it can persist through adolescence activity symptoms are usually the most noticeable and adulthood. The medications most commonly during the preschool and elementary school used to treat ADHD are stimulants, and survey years. Late in elementary and middle school, the inattention symptoms come to the fore.2 data show that abuse of prescription stimulants Among adolescents, hyperactivity may be limited is on the rise. This Advisory discusses the co- to fidgeting and be experienced as feelings of occurrence of ADHD and substance use disorders jitteriness and impatience. DSM-5 notes that (SUDs), the misuse of prescription stimulants, ADHD symptoms wax and wane depending and treatment and prevention approaches to on the circumstance. Close supervision, a new these problems. setting, an engrossing activity, or frequent rewards for appropriate behavior may make symptoms go The Definition of ADHD away temporarily.1 According to the Diagnostic and Statistical Adult ADHD Manual of Mental Disorders (5th ed.; DSM-5),1 the essential feature of ADHD is a persistent For many years, experts believed that children 3 pattern of inattention, hyperactivity-impulsivity and adolescents outgrew ADHD. However, (they are grouped together), or both that interferes research that followed children with ADHD into adulthood showed that the condition can persist with normal functioning and development.1 into adulthood. -
ADHD and Co-Morbid Substance Use Disorder – a Guide for Clinicians
ADHD and co-morbid substance use disorder – a guide for clinicians Background ADHD is a heterogenous behavioural syndrome characterised by the core symptoms of hyperactivity, impulsivity and inattention. While these symptoms tend to cluster together, some people are predominantly hyperactive and impulsive while others are inattentive. Most young people do not use illicit drugs and among those who do only a small number will develop serious problems.1 ADHD and substance misuse can often co-occur.1 However, most studies of ADHD treatment typically exclude those with a substance use disorder.2 Pharmacological treatment of ADHD should not be postponed pending resolution of substance misuse.1 Individuals with substance use disorders (SUDs) and ADHD have an earlier onset of substance abuse than those without ADHD, a greater likelihood of having continuous problems if they develop substance dependence, a reduced likelihood of going into remission, and a tendency to take longer to reach remission. The diagnosis and treatment of ADHD in patients with SUD is essential to achieve the best possible outcome.3 Although the British Association for Psychopharmacology (BAP) highlight that it is unclear what the ideal management of people with concurrent substance use disorders is (e.g. detoxification/behavioural modification before, after or combined with ADHD treatment),4 others suggest that the simultaneous treatment of both conditions is likely to be the optimal approach because ADHD symptoms will interfere with SUD treatment, and substance use will limit the benefit of ADHD treatment.3 In addition, existing evidence indicates that treatment of ADHD with medication does not exacerbate SUD2 or increase the risk of the development of substance misuse in the treated individual.1,5 These guidelines should be read alongside other current guidance (NICE, Trust guidelines and Shared Care Protocols) and they are intended to support a treatment strategy for young people and adults with ADHD who have a co-morbid SUD. -
Teens, Vaping, and Substance
Teens, Vaping and Substance Use Mary Egan, MA, CADC Rosecrance Director of Outreach Even the very best school is a difficult place for a child. Michael Thompson, Ph.D., The Pressured Child Adolescent Development • Physical Changes: • Changes in hormones. • Increases in height and weight. • Mental Changes: • Developing more abstract thinking skills. • Using more logic and reason in decision making. • Forming own beliefs. • Questioning authority. • Heightened focus on physical concerns. • Mental Health First Aid USA Adolescent Development • Emotional Changes: • Shifts mood quickly. • Feels more intensely. • Increases in risk-taking and impulsive behavior. • Social Changes: • Experimentation with different levels of social and cultural identity. • Increase in peer influence. • Awareness of sexual identity. • Learns to manage relationships. • Mental Health First Aid USA Adolescent Development Typical Adolescence Potential Warning Sign Withdrawing from family to Withdrawing from friends, spend more time with friends family and social activity Wanting more privacy Becoming secretive; need for privacy seems to be hiding something Moving from childhood likes Losing interest in favorite to teen pursuits activities and not replacing with other pursuits Youth Mental Health First Aid USA Factors that affect/change drug use trends • Availability • Perception of harm • Cost • Legalization Availability • The more readily available a drug is the higher the risk it will be used Perception of harm • Will this drug cause me harm? • What are the perceived consequences of using a particular drug? Cost • Generally the lower the cost of a drug or the production of the drug the higher the trend to use . Vaping . Stolen prescription medication . Alcohol . Inhalants . Marijuana . Heroin Monitoring the Future • The University of Michigan has an ongoing research project called Monitoring the Future that has followed adolescent substance abuse trends since 1975.