Treatments for Substance Use Disorders

2020 ◽  
pp. 267-324
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Clinical Characteristics ◽  
Black Box ◽  
Brand Names ◽  
Opioid Use ◽  
Childbearing Age ◽  
Black Box Warnings ◽  
Amphetamine Use ◽  
Opioid Use Disorders

The chapter on treatments for substance use disorders discusses and reviews the use of medication-assisted treatments with (a) methadone, buprenorphine/naloxone, and naltrexone for opioid use disorders; (b) disulfiram, acamprosate, naltrexone, and several off-label medications for alcohol use disorders; and (c) nicotine replacement therapies, bupropion, and varenicline for tobacco use disorders. The chapter reviews the mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects of these medications, followed by an in-depth discussion of their clinical use in these disorders. The chapter also briefly reviews several non-Food and Drug Administration (FDA)-approved medicines studied for cocaine, cannabis, and amphetamine use disorders. It also briefly discusses complementary and alternative pharmacotherapies, such as the use of cannabinoids. It also discusses the use of these medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of approved substance use disorder medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

Stimulants and Other ADHD Medicines

2020 ◽  
pp. 231-266
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Eating Disorder ◽  
Clinical Characteristics ◽  
Mechanisms Of Action ◽  
Black Box ◽  
Brand Names ◽  
Clinical Use ◽  
Childbearing Age ◽  
Hyperactivity Disorder ◽  
Medical Disorders ◽  
Black Box Warnings

The chapter on adult attention-deficit/hyperactivity disorder (ADHD) medicines discusses and reviews the use of psychostimulants (such as methylphenidate and amphetamines), and nonstimulants (such as atomoxetine, guanfacine, and clonidine). It reviews their mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects. It further reviews stimulants’ risk of misuse and dependence. The chapter also briefly discusses complementary and alternative pharmacotherapies. It includes an in-depth review of the clinical use of these medications for ADHD (particularly in college students) and for other psychiatric disorders (such as binge-eating disorder) and other medical disorders. It also discusses the use of ADHD medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of ADHD medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Mood Stabilizers

2020 ◽  
pp. 185-230
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Clinical Characteristics ◽  
Bipolar Depression ◽  
Black Box ◽  
Brand Names ◽  
Mood Stabilizers ◽  
Clinical Use ◽  
Omega 3 ◽  
Childbearing Age ◽  
Second Generation Antipsychotics ◽  
Black Box Warnings

The chapter on mood stabilizers discusses and reviews the use of available treatments for bipolar disorder, including lithium, selected anticonvulsants (such as valproate, carbamazepine, oxcarbazepine, and lamotrigine) and second-generation antipsychotics. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and adverse effects. The chapter also reviews emerging pharmacotherapies such as the use of ketamine. It also briefly discusses complementary and alternative pharmacotherapies and the use of omega-3 fatty acids. The chapter includes an in-depth review of the clinical use of the previously listed medications for bipolar depression, mania, mixed episodes, and bipolar maintenance. It also reviews the risks of using antidepressants for bipolar depression. It also discusses the use of mood stabilizers in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of mood stabilizers that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Antipsychotics

2020 ◽  
pp. 121-184
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Clinical Characteristics ◽  
First Generation ◽  
Black Box ◽  
Brand Names ◽  
Clinical Use ◽  
Childbearing Age ◽  
Medical Disorders ◽  
Second Generation Antipsychotics ◽  
Black Box Warnings ◽  
Potential Risks

The chapter on antipsychotics discusses and reviews the use of first-generation antipsychotics, including haloperidol and chlorpromazine, as well as the use of second-generation antipsychotics, including risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, clozapine, paliperidone, iloperidone, asenapine, lurasidone, brexpiprazole, and cariprazine. Pimavanserin is also discussed. The chapter reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and potential risks including neuroleptic side effects such as acute dystonias, parkinsonian symptoms, akathisia, and tardive dyskinesia. Metabolic syndrome (which includes risks of weight gain, hyperglycemia, and hyperlipidemias) and cardiac risks are also discussed. The chapter also briefly discusses complementary and alternative pharmacotherapies. It then provides an in-depth review of the clinical use of antipsychotics for psychotic and behavioral disorders, as well as for other nonpsychotic psychiatric and medical disorders. It also discusses the use of antipsychotics in women of childbearing age, notably in regard to pregnancy and breastfeeding considerations. Finally, the chapter includes a table of antipsychotics that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Anti-Anxiety Medicines and Hypnotics

2020 ◽  
pp. 85-120
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Adverse Effects ◽  
Clinical Characteristics ◽  
Food And Drug Administration ◽  
Mechanisms Of Action ◽  
Black Box ◽  
Abuse Potential ◽  
Brand Names ◽  
Clinical Use ◽  
Childbearing Age ◽  
Black Box Warnings

The chapter on anti-anxiety medicines and hypnotics discusses and reviews the use of benzodiazepines and barbiturates, medicines without abuse potential used for the treatments of anxiety (such as buspirone, propranolol, clonidine, prazosin, hydroxyzine, pregabalin, gabapentin, and quetiapine), as well as newer hypnotics including “z-drugs” considered for insomnia and sleep. It reviews their mechanisms of action, clinical characteristics, potential medication interactions, adverse effects, as well as their risks of dependence and misuse. It also briefly discusses complementary and alternative pharmacotherapies such as melatonin and cannabidiol. The chapter includes an in-depth discussion of the clinical use of these medications for anxiety and insomnia. It also discusses the use of anxiolytics in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of commonly used anti-anxiety medicines and hypnotics that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Antidepressants

2020 ◽  
pp. 15-84
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Clinical Characteristics ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Unipolar Depression ◽  
Black Box ◽  
Brand Names ◽  
Clinical Use ◽  
Childbearing Age ◽  
Medical Disorders ◽  
Black Box Warnings ◽  
Norepinephrine Reuptake

The chapter on antidepressants discusses and reviews the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors, as well as bupropion, mirtazapine, nefazodone, trazodone, and the newer antidepressants vilazodone and vortioxetine. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, adverse effects, and other risks. The chapter also reviews emerging pharmacotherapies such as ketamine, esketamine, and brexanolone. It also briefly discusses complementary and alternative pharmacotherapies. The chapter includes an in-depth discussion of the clinical use of antidepressants for the treatment of unipolar depression and other psychiatric and medical disorders. It also discusses the use of antidepressants in women of childbearing age, notably in regards to pregnancy and breastfeeding considerations. Finally, each chapter includes a table of antidepressants that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder

2021 ◽  
Vol 49 (3) ◽  
pp. 388-403
Author(s):  
William H. Gottdiener
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Psychodynamic Psychotherapy ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Self Medication ◽  
The Core ◽  
Wide Range ◽  
Opioid Use Disorders

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

Substance Use Disorders

2019 ◽  
Author(s):  
Erik A. Levinsohn ◽  
Kevin P. Hill
Keyword(s):  
Substance Use ◽  
General Population ◽  
Substance Use Disorders ◽  
Substance Use Disorder ◽  
General Framework ◽  
Opioid Use ◽  
Diagnosis And Management ◽  
Conceptual Background ◽  
Opioid Use Disorders

Given the incredible scope of substance use disorders, this chapter will primarily focus on alcohol and opioid use disorders, while also discussing substance use broadly. Furthermore, this chapter does not provide detailed guidelines for managing patients with a substance use disorder. Instead, this review aims to provide the reader with conceptual background of the biology of addiction as well as a general framework for its diagnosis and management. While this chapter primarily focuses on physicians in the role of caregiver, it is important to note that physicians also struggle with SUDs, at a rate near that of the general population.25 This review contains 3 tables and 25 references.

scholarly journals Attitudinal Barriers to Analgesic Use among Patients with Substance Use Disorders

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Leah Zallman ◽  
Sonia L. Rubens ◽  
Richard Saitz ◽  
Jeffrey H. Samet ◽  
Christine Lloyd-Travaglini ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Substance Use ◽  
Side Effects ◽  
Substance Use Disorders ◽  
Opioid Use ◽  
Attitudinal Barriers ◽  
Primary Care Patients ◽  
Opioid Use Disorders ◽  
Analgesic Use

Attitudinal barriers towards analgesic use among primary care patients with chronic pain and substance use disorders (SUDs) are not well understood. We evaluated the prevalence of moderate to significant attitudinal barriers to analgesic use among 597 primary care patients with chronic pain and current analgesic use with 3 subscales from the Barriers Questionaire II: concern about side effects, fear of addiction, and worry about reporting pain to physicians. Concern about side effects was a greater barrier for those with opioid use disorders (OUDs) and non-opioid SUDs than for those with no SUD (OR (95% CI): 2.30 (1.44–3.68), P<0.001 and 1.64 (1.02–2.65), P=0.041, resp.). Fear of addiction was a greater barrier for those with OUDs as compared to those with non-opioid SUDs (OR (95% CI): 2.12 (1.04–4.30), P=0.038) and no SUD (OR (95% CI): 2.69 (1.44–5.03), P=0.002). Conversely, participants with non-opioid SUDs reported lower levels of worry about reporting pain to physicians than those with no SUD (OR (95% CI): 0.43 (0.24–0.76), P=0.004). Participants with OUDs reported higher levels of worry about reporting pain than those with non-opioid SUDs (OR (95% CI): 1.91 (1.01–3.60), P=0.045). Concerns about side effects and fear of addiction can be barriers to analgesic use, moreso for people with SUDs and OUDs.

scholarly journals ILC-OPI: impulsive lifestyle counselling versus cognitive behavioral therapy to improve retention of patients with opioid use disorders and externalizing behavior: study protocol for a multicenter, randomized, controlled, superiority trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Morten Hesse ◽  
Birgitte Thylstrup ◽  
Sidsel Helena Karsberg ◽  
Michael Mulbjerg Pedersen ◽  
Mads Uffe Pedersen
Keyword(s):  
Clinical Trial ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Externalizing Behavior ◽  
Behavioral Therapy ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Randomized Controlled ◽  
Lifestyle Counselling ◽  
Opioid Use Disorders

Abstract Background Substance use disorders show a high comorbidity with externalizing behavior difficulties, creating treatment challenges, including difficulties with compliance, a high risk of conflict, and a high rate of offending post-treatment. Compared with people with other substance use disorders those with opioid use disorders have the highest risk of criminal activity, but studies on the evidence base for psychosocial treatment in opioid agonist treatment (OAT) are scarce. The Impulsive Lifestyle Counselling (ILC) program may be associated with better retention and outcomes among difficult-to-treat patients with this comorbidity. Methods The study is a multicenter, randomized, controlled, superiority clinical trial. Participants will be a total of 137 hard-to-treat individuals enrolled in opioid agonist treatment (OAT). Participants will be randomized to either a standard treatment (14 sessions of individual manual-based cognitive behavioral therapy and motivational interviewing (MOVE-I)) or six sessions of ILC followed by nine sessions of MOVE-I. All participants will receive personalized text reminders prior to each session and vouchers for attendance, as well as medication as needed. The primary outcome is retention in treatment. Secondary measures include severity of drug use and days of criminal offending for profit three and nine months post-randomization. A secondary aim is, through a case-control study, to investigate whether participants in the trial differ from patients receiving treatment as usual in municipalities where ILC and MOVE-I have not been implemented in OAT. This will be done by comparing number of offences leading to conviction 12 months post-randomization recorded in the national criminal justice register and number of emergency room contacts 12 months post-randomization recorded in the national hospital register. Discussion This is the first randomized, controlled clinical trial in OAT to test the effectiveness of ILC against a standardized comparison with structural elements to increase the likelihood of exposure to the elements of treatment. Results obtained from this study may have important clinical, social, and economic implications for publicly funded treatment of opioid use disorder. Trial registration ISRCTN, ISRCTN19554367, registered on 04/09/2020.

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