The Addiction Casebook This page intentionally left blank The Addiction Casebook Edited by Petros Levounis, M.D., M.A. Abigail J. Herron, D.O. Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we rec- ommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. 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American Psychiatric Publishing A Division of American Psychiatric Association 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data The addiction casebook / [edited by] Petros Levounis, Abigail J. Herron. — First edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58562-458-4 (pbk. : alk. paper) I. Levounis, Petros, editor of compilation. II. Herron, Abigail J., 1977– editor of com- pilation. III. American Psychiatric Association, issuing body. [DNLM: 1. Substance-Related Disorders—Case Reports. 2. Behavior, Addictive—Case Reports. WM 270] RC564.29 362.29--dc23 2013041547 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors. .vii Preface. xi Part I. Introduction 1 DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. 3 Deborah S. Hasin, Ph.D. Erin M. Delker, M.P.H. Part II. Substance-Related Disorders 2 Alcohol: Conundrums of Co-occurring Disorders . .21 Faye Chao, M.D. 3 Caffeine: The Ins and Outs of Caffeine . .33 Gary P. Katzman, M.D. 4 Cannabis: A Natural Dilemma . .51 Timothy K. Brennan, M.D., M.P.H. Saadiq J. Bey, M.S.W., CASAC, ICADC 5 Hallucinogens: The Mind Field of Oswald: A Case of Hallucinogen Intoxication. .69 Elias Dakwar, M.D. 6 Inhalants: Just say N2O! . .91 Aykut Ozden, M.D. Shaneel Shah, M.D. 7 Opioids: Finding the Off Switch . .105 Glenn Occhiogrosso, M.D. Susan D. Whitley, M.D. 8 Sedatives, Hypnotics, or Anxiolytics: Sleepless Nights and the Magic Pills . .121 Claudie H. Jimenez, M.D., M.S. Abigail J. Herron, D.O. 9 Stimulants: Sex, Drugs, and Techno: Gay Men and Crystal Methamphetamine. .135 Joe Ruggiero, Ph.D. 10 Tobacco: From Social Norm to Modern Day Faux Pas. .151 Robbie Bahl, M.D. Petros Levounis, M.D., M.A. 11 Other (or Unknown) Substances: The Brave New World of Bath Salts and Other Synthetic Drugs . .163 Petros Levounis, M.D., M.A. Michael Ascher, M.D. Part III. Non-Substance-Related Disorder 12 Gambling: The Woman Who Became Tired of Trying to Predict the Future . .179 Mayumi Okuda, M.D. Silvia Bernardi, M.D. Carlos Blanco, M.D., Ph.D. Part IV. Condition for Further Study 13 Internet: Why Are Drug Addicts and People Who Use the Internet Both Called “Users?”. .191 Steven Joseph Lee, M.D. Index . .209 Contributors Michael Ascher, M.D. Fellow, Department of Psychiatry, Hospital of the University of Pennsylvania Addictions Fellowship Program, Philadelphia Veterans Administration Medi- cal Center, Philadelphia, Pennsylvania Robbie Bahl, M.D. Medical Director, Cedar Hill Hospital, Portland, Oregon Silvia Bernardi, M.D. Postdoctoral Residency Fellow, Department of Psychiatry, New York State Psy- chiatric Institute/Columbia University, New York, New York Saadiq J. Bey, M.S.W., CASAC, ICADC Research Assistant, AIDS Community Research Initiative of America, New York, New York Carlos Blanco, M.D., Ph.D. Professor of Clinical Psychiatry, Department of Psychiatry, New York State Psy- chiatric Institute/Columbia University, New York, New York Timothy K. Brennan, M.D., M.P.H. Associate Director, Fellowship in Addiction Medicine and Attending Physician, Addiction Institute of New York, New York, New York Faye Chao, M.D. Unit Chief, Inpatient Service, Addiction Institute of New York, St. Luke’s– Roosevelt Hospital Center, New York, New York Elias Dakwar, M.D. Assistant Professor of Clinical Psychiatry, Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, New York vii viii The Addiction Casebook Erin M. Delker, M.P.H. New York State Psychiatric Institute, New York, New York Deborah S. Hasin, Ph.D. Department of Psychiatry, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University; New York State Psychiatric Institute, New York, New York Abigail J. Herron, D.O. Director, Fellowship in Addiction Medicine, and Acting Medical Director, Ad- diction Institute of New York, St. Luke’s–Roosevelt Hospital Center, New York, New York Claudie H. Jimenez, M.D., M.S. Medical Director, Chemical Dependency Services, Harlem East Life Plan, New York, Ne w York Gary P. Katzman, M.D. Clinical Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, Ne w York Steven Joseph Lee, M.D. Petros Levounis, M.D., M.A. Chair, Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey Glenn Occhiogrosso, M.D. Unit Chief, Inpatient Detoxification Service, Kings County Hospital Center, Brooklyn, New York Mayumi Okuda, M.D. Postdoctoral Residency Fellow, Department of Psychiatry, New York State Psy- chiatric Institute/Columbia University, New York, New York Aykut Ozden, M.D. Clinical Assistant Professor of Psychiatry, Columbia University College of Phy- sicians and Surgeons; Director, Comprehensive Assessment Center, Depart- ment of Psychiatry, St. Luke’s–Roosevelt Hospital Center, New York, New York Contributors ix Joe Ruggiero, Ph.D. Assistant Clinical Director, Addiction Institute of New York; Director, Crystal Clear Project, St. Luke’s–Roosevelt Hospital Center, New York, New York Shaneel Shah, M.D. Child and Adolescent Psychiatry Fellow, Child and Adolescent Psychiatry Di- vision, Department of Psychiatry, St. Luke’s–Roosevelt Hospital Center, New York, New York Susan D. Whitley, M.D. Director of Chemical Dependency Services, Kings County Hospital Center; Clinical Assistant Professor of Psychiatry and Family Medicine, State University of New York Downstate, Brooklyn, New York x The Addiction Casebook Disclosure of Interests The following contributors have indicated that they have no financial interests or other affiliations that represent or could appear to represent a competing interest with their contributions to this book: Michael Ascher, M.D.; Robbie Bahl, M.D., Saadiq J. Bey, M.S.W., CASAC, ICADC; Timothy K. Brennan, M.D., M.P.H.; Faye Chao, M.D.; Elias Dakwar, M.D.; Deborah S. Hasin, Ph.D.; Abigail J. Herron, D.O.; Claudie H. Jimenez, M.D., M.S.; Gary P. Katzman, M.D.; Steven Joseph Lee, M.D.; Petros Levounis, M.D., M.A.; Mayumi Okuda, M.D.; Aykut Ozden, M.D.; Joe Ruggiero, Ph.D.; Shaneel Shah, M.D.; Susan D. Whitley, M.D. Preface FEW illnesses come with more stigma and misunderstanding than the addic- tions. The majority of our patients who have substance use disorders are not properly diagnosed and do not receive adequate medical care. Yet working with these patients is both scientifically fascinating and immensely rewarding. Although this casebook is far from complete in covering the breadth and depth of our current knowledge in the diagnosis and treatment of substance use and other addictive disorders, we hope that it will provide the fundamental tools for working with the substance-using patient in the hospital, the clinic, and the community. The book begins with an introductory chapter that outlines the progression of our thinking in terms of psychiatric diagnosis as we move from DSM-IV-TR (American Psychiatric Association 2000) to DSM-5 (American Psychiatric Asso- ciation 2013). This first chapter is different in tone and format from the rest of the book and explains the reasoning behind the change in criteria sets and the broad- ening of the concept of addictive disorders to include the behavioral addictions. It is followed by 12 case studies with assessment tools and treatment recommenda- tions. Each case study introduces a patient with an addiction DSM-5 diagnosis (except for the last chapter on problematic Internet use) followed by a discussion that illustrates common ways of working with addicted patients. An additional goal of the book is to show clinicians who have little experience in this area the in- tersection of addiction with other psychiatric diagnoses. This casebook has been a collaboration of three generations of addiction specialists. We have invited our peers, as well as our mentors and our students, to join us in formulating the most salient ideas and suggestions that we have found helpful for treating people who are dealing with substance use and other addictions. We are indebted to them for their great insights and clinical wisdom.