Creating an ethical culture to support recovery from substance use disorders

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments.

Clinical Management of Drug Use Disorders

10.2310/psych.13042 ◽

2017 ◽

Author(s):

Alexander Thompson ◽

Timothy Ando ◽

James Jackson

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Substance Dependence ◽

Synthetic Cannabinoids ◽

The United States ◽

Health Concern ◽

Treatment And Prevention ◽

Drug Use Disorders ◽

Significant Public Health

Despite mammoth efforts toward the treatment and prevention of substance use disorders in the United States over the past 30 years, they remain a significant public health concern and an all-too-common comorbidity among people with other forms of mental illness. Continued research into genetics, pharmacotherapies, psychotherapies, and epidemiology for substance use disorders results in huge amounts of new information for clinicians to assimilate each year. This review summarizes current diagnostic and categorical standards in substance use disorders, epidemiology, genetic and physiologic factors in addiction for each class, clinically relevant laboratory testing, evidence-based treatments, and prognostic considerations in substance use disorders. Specifically, sections cover cannabinoids, hallucinogens, opioids, sedatives, and stimulants. Key words: benzodiazepines, cannabis, drug dependence, hallucinogens, MDMA, substance abuse, substance dependence, synthetic cannabinoids

The Complex Relationship Between Eating Disorders and Substance Use Disorders

Clinical Handbook of Complex and Atypical Eating Disorders ◽

10.1093/med-psych/9780190630409.003.0004 ◽

2017 ◽

pp. 60-78

Author(s):

Amy Baker Dennis ◽

Tamara Pryor

Keyword(s):

Eating Disorders ◽

Substance Use ◽

Substance Use Disorders ◽

Treatment Plan ◽

Integrated Treatment ◽

Evidence Based ◽

Complex Relationship ◽

Adaptive Function ◽

Case Examples ◽

Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treated in a comprehensive integrated manner. This chapter elucidates the complex relationship between ED and SUD to help the treating professional create an integrated treatment plan that addresses both disorders and any other co-occurring conditions. Evidence-based treatments for each disorder are discussed, and recommendations on how to take “best practices” from both fields to formulate a treatment plan that addresses the specific needs of the patient are presented. The chapter includes case examples that demonstrate the importance of understanding the adaptive function of both disorders when developing an effective intervention.

Evidence-Based Treatments for Substance Use Disorders

FOCUS The Journal of Lifelong Learning in Psychiatry ◽

10.1176/foc.1.2.115 ◽

2003 ◽

Vol 1 (2) ◽

pp. 115-122 ◽

Cited By ~ 3

Author(s):

Paul B. Gold ◽

Kathleen T. Brady

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Evidence Based ◽

Novel technologies in detection, treatment and prevention of substance use disorders

Journal of Food and Drug Analysis ◽

10.1016/j.jfda.2018.09.003 ◽

2019 ◽

Vol 27 (1) ◽

pp. 22-31 ◽

Cited By ~ 2

Author(s):

Hichem Moulahoum ◽

Figen Zihnioglu ◽

Suna Timur ◽

Hakan Coskunol

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Novel Technologies ◽

Treatment And Prevention

Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities ◽

Evidence-Based Alcohol and Substance Use Disorder Treatment with Sexual and Gender Minorities

10.1093/med-psych/9780190669300.003.0010 ◽

2019 ◽

pp. 222-243

Author(s):

Adam W. Carrico ◽

Walter Gómez ◽

Cathy J. Reback

Keyword(s):

Substance Use ◽

Clinical Research ◽

Substance Use Disorders ◽

Substance Use Disorder ◽

Evidence Based ◽

Sexual Minority Women ◽

Substance Use Disorder Treatment ◽

Disorder Treatment ◽

And Gender

Although sexual and gender minority (SGM) populations remain at markedly elevated risk for developing alcohol and substance use disorders, relatively few substance use disorder treatment programs provide culturally tailored services. This chapter provides an overview of alcohol and substance use disparities as well as reviews evidence-based interventions in distinct SGM populations. In general, clinical research has focused on culturally tailoring evidence-based substance use disorder treatments such as cognitive–behavioral therapy and motivational interviewing with modest success. Further clinical research should develop and test novel substance use disorder intervention approaches that address minority stress processes as key triggers for unhealthy alcohol consumption and substance use. Clinical research is also needed to address the disparities in unhealthy drinking among sexual minority women as well as alcohol and substance use disparities in transgender individuals. Recommendations are provided to optimize the effectiveness and scalability of existing evidence-based treatments targeting alcohol and substance use disorders in SGM populations.

Meta-Analysis on the Effect of Contingency Management for Patients with Both Psychotic Disorders and Substance Use Disorders

Journal of Clinical Medicine ◽

10.3390/jcm10040616 ◽

2021 ◽

Vol 10 (4) ◽

pp. 616

Author(s):

Marianne Destoop ◽

Lise Docx ◽

Manuel Morrens ◽

Geert Dom

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Psychotic Disorders ◽

Meta Analysis ◽

Contingency Management ◽

Potential Effect ◽

Clinical Population ◽

Clinical Implementation ◽

Effective Interventions ◽

Background: Substance use disorders (SUD) are highly prevalent among psychotic patients and are associated with poorer clinical and functional outcomes. Effective interventions for this clinical population are scarce and challenging. Contingency management (CM) is one of the most evidence-based treatments for SUD’s, however, a meta-analysis of the effect of CM in patients with a dual diagnosis of psychotic disorder and SUD has not been performed. Methods: We searched PubMed and PsycINFO databases up to December 2020. Results: Five controlled trials involving 892 patients were included. CM is effective on abstinence rates, measured by the number of self-reported days of using after intervention (95% CI −0.98 to −0.06) and by the number of negative breath or urine samples after intervention (OR 2.13; 95% CI 0.97 to 4.69) and follow-up (OR 1.47; 95% CI 1.04 to 2.08). Conclusions: Our meta-analysis shows a potential effect of CM on abstinence for patients with SUD and (severe) psychotic disorders, although the number of studies is limited. Additional longitudinal studies are needed to confirm the sustained effectivity of CM and give support for a larger clinical implementation of CM within services targeting these vulnerable co-morbid patients.

Substance Use Disorders

Management of Sleep Disorders in Psychiatry ◽

10.1093/med/9780190929671.003.0022 ◽

2020 ◽

pp. 372-386

Author(s):

Shirshendu Sinha ◽

Bhanu Prakash Kolla ◽

Meghna P. Mansukhani

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Sleep Disturbances ◽

Time Course ◽

Drugs Of Abuse ◽

Treatment Options ◽

Treatment Strategies ◽

Specific Treatment ◽

Early Recovery ◽

Individual Substance

Sleep disturbances although highly prevalent conditions in patients with substance use disorders, they are underreported, underrecognized, underdiagnosed, and often untreated. Alcohol and various drugs of abuse interfere with the initiation and maintenance of sleep. The sleep disturbances can be experienced during active substance use including intoxication as well as during early recovery. Literature also indicates insomnia is a risk factor for substance abuse. Thus sleep disturbances can play a major role in initiating and maintaining substance use and increase the risk of relapse. This review describes the existing literature on the bidirectional relationships between sleep disturbances and substance use disorders in the context of alcohol, cannabis, opioid, and cocaine use disorders. Evidence with regards the type and severity of the sleep disruption, its time course, relationship to relapse, and treatment options when available are discussed. Specific treatment strategies focused on individual substance-related sleep disturbances will improve global outcome in substance use disorders and sleep and enhance the quality of life of the patients.

Substance Use Disorders in Global Mental Health Delivery: Epidemiology, Treatment Gap, and Implementation of Evidence-Based Treatments

Harvard Review of Psychiatry ◽

10.1097/hrp.0000000000000271 ◽

2020 ◽

Vol 28 (5) ◽

pp. 316-327

Author(s):

Hilary S. Connery ◽

R. Kathryn McHugh ◽

Meghan Reilly ◽

Sonya Shin ◽

Shelly F. Greenfield

Keyword(s):

Mental Health ◽

Substance Use ◽

Substance Use Disorders ◽

Global Mental Health ◽

Evidence Based ◽

Treatment Gap ◽

Health Delivery ◽

Clinical Management of Drug Use Disorders

10.2310/cannabis.13042 ◽

2017 ◽

Author(s):

Alexander Thompson ◽

Timothy Ando ◽

James Jackson

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Substance Dependence ◽

Synthetic Cannabinoids ◽

The United States ◽

Health Concern ◽

Treatment And Prevention ◽

Drug Use Disorders ◽

Significant Public Health

Substance Use Disorders

10.1093/med/9780190920197.001.0001 ◽

2020 ◽

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Evidence Based ◽

Need For Treatment ◽

The Past ◽

The Us ◽

Behavioral Therapies ◽

Illegal Activities ◽

Lay Public

Over the past few years there has been an increased interest in the identification and treatment of substance use disorders, due at least in part to the widespread drug overdose epidemic. Clinicians and the lay public have gained a greater understanding of the need for treatment of substance use disorders and the consequences of avoiding treatment. In addition, there has been a growing understanding of substance use disorders as medical or mental health disorders, rather than as character flaws or merely illegal activities. This book builds on this nascent understanding and presents epidemiology, basic science, and treatment from the perspective of a clinician who wants to gain the knowledge and background needed to work with this patient population. The overall theme of the book is to discuss evidence-based rather than anecdotal or unproved treatments. Section I begins with the epidemiology, etiology, and neurobiology of substance use disorders, including preclinical data. Section II discusses pharmacotherapy for substance use disorders, focusing on medications approved by the US Food and Drug Administration (FDA). Section III focuses on other evidence-based treatments for substance use disorders, including behavioral therapies, and ends with potential future treatments.