Substance Use Disorders and the Impaired Physician

2021 ◽  
pp. 211-222
Author(s):  
Gia Merlo
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Prescription Drugs ◽  
High Stress ◽  
Healthcare Services ◽  
Washington Dc ◽  
Addictive Disorders ◽  
Physician Health ◽  
Ease Of Access ◽  
Culture Of Silence

Patient safety is jeopardized when healthcare services are provided by physicians who suffer from substance use disorders (SUDs). When focusing on the problem of substance abuse and dependence among physicians, certain factors inherent in the medical field, such as long hours, the high-stress nature of the work, and the ease of access to drugs, make physicians more susceptible to abusing or becoming dependent on prescription drugs and alcohol. SUDs may differ in severity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association, 2013) provides three severity specifiers: mild, moderate, and severe. Severe SUDs are also known as addictive disorders. To make matters worse, a culture of silence exists among colleagues, who often seek to protect the compromised physician from the legal consequences of abusing drugs. Luckily, the compromised physician can be provided with an intense and individualized treatment regime through physician health programs that aim for rehabilitation over termination of employment.

Introduction

2016 ◽  
Author(s):  
Maria A. Sullivan ◽  
Frances R. Levin
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Prescription Drugs ◽  
Help Seeking ◽  
Clinical Skills ◽  
Specific Treatment ◽  
Older Americans ◽  
Addictive Disorders ◽  
Withdrawal Syndromes

Alcohol and substance-use disorders in late life have been under-studied. Alcohol and prescription drugs are frequently abused by older Americans, yet addictive disorders are often difficult to identify in this population because of screening instruments adapted to younger adults, stigma and shame that limit help-seeking in older adults, and co-occurring medical and psychiatric conditions that mimic or mask both acute effects and withdrawal syndromes associated with alcohol or substance-use disorders. We will review the evidence for the effectiveness of motivational brief interventions in this population, the need to modify certain pharmacotherapies, including standard detoxification regimens, as well as how to develop age-specific treatment services which tailor the content and pace of presentation toward older adults. Older patients can demonstrate equally or more successful outcomes than younger individuals. This text is intended as a practical handbook to enhance clinical skills in identifying and treating addiction in older adults.

Overview of Substance Use Disorders

2017 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Significant Proportion ◽  
The United States ◽  
Public Attention ◽  
Addictive Disorders ◽  
Management Concepts ◽  
Drug Overdoses ◽  
Sedative Hypnotics ◽  
Withdrawal Syndromes

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal

Overview of Substance Use Disorders

2018 ◽  
Author(s):  
Alexander W Thompson ◽  
Timothy Ando ◽  
Emily Morse
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Significant Proportion ◽  
The United States ◽  
Public Attention ◽  
Addictive Disorders ◽  
Management Concepts ◽  
Drug Overdoses ◽  
Sedative Hypnotics ◽  
Withdrawal Syndromes

Substance use disorders are a major source of morbidity and mortality, contributing to a significant proportion of deaths in the United States and worldwide each year. A substantial rise in deaths related to drug overdoses in recent decades has drawn increasing public attention to this issue. However, the majority of individuals struggling with substance use disorders remain untreated. The financial costs and health burden are substantial. This review provides a broad overview of substance-related and addictive disorders. The evolution of the classification system is described, and the diagnostic criteria for the various substance use disorders are reviewed. Epidemiology and etiologic considerations, including neurobiological pathways, genetics, environmental influences, and dimensional risk factors, are examined. Finally, individual substances and their related disorders are reviewed, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedative/hypnotics, stimulants, tobacco, and other or unknown substances. Intoxication and withdrawal syndromes are described where applicable, and clinical management concepts are discussed.  This review contains 6 figures, 5 tables, and 71 references. Key words: abuse, addiction, alcohol, caffeine, cannabis, dependence, diagnosis, DSM-5, epidemiology, hallucinogen, hypnotic, inhalant, intoxication, methamphetamine, nicotine, opioid, sedative, stimulant, substance use disorders, tobacco, tolerance, withdrawal

Substance Use Disorders, Personality Disorders, and Eating Disorders

2016 ◽  
pp. 711-714
Author(s):  
Brian A. Palmer
Keyword(s):  
Eating Disorders ◽  
Substance Use ◽  
Personality Disorders ◽  
Substance Use Disorders ◽  
Prescription Drugs ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Medical Settings ◽  
Generic Term ◽  
And Behavior

Psychosis is a generic term used to describe altered thought and behavior in which the patient is incapable of interpreting his or her situation rationally and accurately. Psychotic symptoms can occur in various medical, neurologic, and psychiatric disorders. Many psychotic reactions seen in medical settings are associated with the use of recreational or prescription drugs. Some of these drug-induced psychotic reactions are nearly indistinguishable from schizophrenia in terms of hallucinations and paranoid delusions.

Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada

Crisis ◽  
2019 ◽  
Vol 40 (3) ◽  
pp. 166-175 ◽  
Author(s):  
Alexandre Mikhail ◽  
Omaid Tanoli ◽  
Gilles Légaré ◽  
Pierre-André Dubé ◽  
Youssef Habel ◽  
...  
Keyword(s):  
Substance Use ◽  
Suicide Attempt ◽  
Substance Use Disorders ◽  
Prescription Drugs ◽  
Suicide Attempts ◽  
Patient Characteristics ◽  
Cross Sectional ◽  
Over The Counter ◽  
Otc Drugs ◽  
Do So

Abstract. Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009–2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.

Substance-Related and Addictive Disorders

2017 ◽  
pp. 175-178
Author(s):  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Gerald L. Klerman
Keyword(s):  
Substance Abuse ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Substance Use Disorder ◽  
Relapse Prevention ◽  
Addictive Disorders ◽  
Better Than

This chapter includes an overview of the use of IPT for patients with substance abuse (e.g., alcohol, opiates, cocaine, and nicotine) and addictive disorders. The available data do not allow us to recommend IPT as a treatment for patients with a substance use disorder. There have been several negative IPT trials in this population, and in this setting IPT has been found to be no better than a control condition. However, some small studies in process are more optimistic for its use in narrowly defined samples. Based on the published literature, approaches other than IPT that focus on sobriety or relapse prevention may be preferable for patients with substance use disorders. IPT has never been intended as a treatment for all patients with all conditions, and substance abuse may be an area where its application has limited utility.

Turn the Next Page

2020 ◽  
pp. 327-356
Author(s):  
Kathryn A. Cunningham ◽  
Amanda E. Price ◽  
F. Gerard Moeller ◽  
Noelle C. Anastasio
Keyword(s):  
Substance Use ◽  
Eating Disorder ◽  
Substance Use Disorders ◽  
Binge Eating Disorder ◽  
Treatment Strategies ◽  
Cognitive Restructuring ◽  
Neural Systems ◽  
Addictive Disorders ◽  
Brain Circuitry ◽  
Optimal Window

Contemporary research has enriched our knowledge of mechanisms involved in the generation and persistence of the debilitating disorders characterized by an “addictive dimensionality,” such as substance use disorders and binge eating disorder. Personalized treatment strategies for addictive disorders might include one or a combination of medications at important stages in detoxification and recovery to reduce craving, assist in establishing a substance-free state, and open the optimal window to allow cognitive restructuring and enhanced inhibitory control of substance-seeking. The overlapping neural systems and brain circuitry involved across addictive disorders have elevated interest in the metabolic and neural regulators serotonin (5-hydroxytryptamine; 5-HT) and ghrelin. This chapter focuses on these systems as examples of how we can broaden our horizons for advancing future therapeutic and biomarker initiatives.

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