Treatment of Alcohol and Other Drug Dependence

Size: px
Start display at page:

Download "Treatment of Alcohol and Other Drug Dependence"

Transcription

1 LIVER TRANSPLANTATION 13:S59-S64, 2007 SUPPLEMENT Treatment of Alcohol and Other Drug Dependence Richard Saitz Departments of Medicine and Epidemiology, Youth Alcohol Prevention Center, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University and Boston Medical Center, Boston, MA KEY CONCEPTS Addiction (e.g., alcohol or drugs) is a chronic disease. Specific behavioral and pharmacological treatments have proven efficacy. Addressing addiction includes intervention for risky and problem use. Clinicians who are not addiction specialists can play important roles in addressing addiction. Liver Transpl 13:S59-S64, AASLD. Unhealthy alcohol and drug use are associated with substantial morbidity, disability, mortality, and costs. 1,2 They are among the leading preventable causes of death and disability. Most cases of esophageal cancer, 60% of chronic pancreatitis, 50% of cirrhosis and chronic hepatitis, 42% of acute pancreatitis, and substantial proportions of other medical illnesses including human immunodeficiency virus (HIV) and injuries are attributable to alcohol and other drugs. More than 100,000 people in the United States die each year as a result of alcohol and illicit drugs. In the United States, substance (alcohol and drug) use cost far more than other common medical illnesses over $400 billion a year, compared with approximately a quarter of that sum for coronary heart disease and an eighth of that sum for obstructive lung disease and asthma. Despite these consequences and costs, and despite the fact that over a third of hospital admissions are related to unhealthy alcohol and other drug use, most such patients do not receive addiction treatment. But efficacious treatments exist. Tobacco addiction is more common and causes more deaths than alcohol or other drug use. It can be treated effectively with brief advice, individual and group counseling, and several medications (nicotine replacement, bupropion, varenicline). But this review of addiction treatment focuses on alcohol and other drug use, excluding tobacco, a topic worthy of separate focus. For alcohol and other drug disorders, behavioral and pharmacological treatments have proven efficacy. A number of these treatments have been proven effective relatively recently, have not yet been widely disseminated into practice, and can be implemented outside of addiction specialty treatment settings. 3,4 Finally, unhealthy use of substances by people who have not yet met diagnostic criteria for a substance use disorder can also be effectively treated with brief interventions. These interventions are of particular importance to clinicians who are not addiction specialists because they are brief and can be done by nonspecialists. These clinicians also have critical roles in facilitating receipt of addiction treatment by their patients. But before discussing specific treatments, it is important to consider the fact that addiction is a chronic disease, so that expectations of treatment outcome are appropriate. 5 Treating addiction is perhaps more like treating and managing asthma and diabetes than it is like curing a bacterial infection. ADDICTION IS A CHRONIC DISEASE Alcohol and drug (substance) dependence share a number of features in common with other common chronic illnesses. 6 These include the following: physiologic basis; diagnosis; definable risk factors; heritability; poor adherence to treatment; no cure; relapse common; longitudinal care required; and denial. Substance dependence has a physiologic basis. For example, people with alcohol dependence, even during abstinence, have reduced gamma-aminobutyric acid Abbreviations: HIV, human immunodeficiency virus; GABA, gamma-aminobutyric acid; AA, Alcoholics Anonymous. Address reprint requests to: Richard Saitz, Departments of Medicine and Epidemiology, Youth Alcohol Prevention Center, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University and Boston Medical Center, 91 East Concord Street 200, Boston, MA Telephone: ; Fax: ; rsaitz@bu.edu DOI /lt Published online in Wiley InterScience ( Liver Transplantation, Vol 13, No 11, Suppl 2 (November), 2007: pp S59-S64 S59

2 S60 SAITZ (GABA) receptors in the brain, as measured by single positron emission tomography, than do people without alcohol dependence. Alcohol potentiates inhibitory GABA transmission in the central nervous system. These decreases in central GABA receptors may therefore be related to the uncontrollable desire to drink seen in people with dependence. Whether these changes are a cause or effect of heavy drinking is not known. Physiologic characteristics that do appear to have causal roles are enzymatic activities that lead to higher levels of serum acetaldehyde after drinking (e.g., aldehyde dehydrogenase deficiency). These higher amounts of acetaldehyde that are unpleasant (e.g., nausea) are associated with a lower risk for alcohol dependence. Substance dependence can be reliably diagnosed. Although there is no laboratory test, structured interviews (and expert clinicians) yield diagnoses with consistency. These diagnoses have prognostic value in terms of natural history and treatment response. Substance dependence has definable risk factors, and like other common chronic illnesses has a substantial genetic etiology although also similarly, there is no single gene responsible for the risk. Just over 50% of alcohol dependence is related to nonshared environmental influences (e.g., peers, bad childhood experiences). The remainder is related to genetics. In adoption studies, having a parent with alcohol dependence doubles the risk. About one-third of identical twins will have alcohol dependence if their twin has it. Epidemiologic studies have identified specific genes that increase risk. For example, genes involved in dopamine synthesis, which is critical for the reward pathway where all substances of abuse have action, increase the risk. And the gene that includes the locus that codes for alcohol dehydrogenase has been identified as a risk factor for alcohol dependence. As with other chronic medical illnesses, treatments are effective but are often not adhered to, there are no cures, and relapse is common. Similarly, substance dependence affects physical, social, and emotional well-being, and requires longitudinal health care. After alcohol-dependence treatment, 40-60% of patients are abstinent 1 year later, and an additional 15-30% have not returned to dependent drinking. In comparison, adherence to medication regimens in diabetes, hypertension, and asthma are 30-50% and are generally even worse for nonpharmacological treatments. Relapse, or recurrence of symptoms requiring additional medical care to establish remission of symptoms of these diseases, is actually similar to that seen in substance dependence (up to 70%). And these observations are true despite that fact that in practice, substance dependence treatment is often short term. Despite this, relapse rates are not 100%, as would be the case for diabetes treated only in the short term. Last, even one of the classic characteristics of alcoholism, denial, is a common feature among patients with other chronic illnesses like diabetes and hypertension. Denial is a common response to being accused of (or diagnosed with) having an undesirable characteristic. In the United States, although there are addiction medicine specialists, most addiction treatment is delivered in specialty treatment programs by substance abuse counselors. The view from outside this system is often that patients should go to detox. Detoxification is useful when patients are beginning to cut down or abstain, and it is valuable as a first step in treatment. Physical and emotional symptoms of withdrawal can be ameliorated by using medications cross-tolerant to the substance being used (e.g., benzodiazepines for alcohol withdrawal). But detoxification alone (most often done in ambulatory settings) is not addiction treatment, in that it does not prevent relapse. For example, 20% of patients with opioid dependence are abstinent 1 year after detoxification alone. Unfortunately, most patients who undergo detoxification in the United States do not receive further addiction treatment. Addiction treatment is aimed at decreasing the chronic consequences of uncontrolled substance use, including physical and interpersonal consequences, and social, psychological, legal, and employment problems. In addition, treatment aims to reduce substance use, including lapses (usually defined as use on one occasion) and relapses (usually defined as more than one occasion of heavy use). TREATMENT What Is Addiction Treatment? Alcohol treatment includes access to psychological, medical, employment, legal, and social services, sometimes removal from a drinking or otherwise harmful environment, use of mutual (self)-help groups, pharmacotherapy, and counseling by both specialists and nonspecialists. This counseling includes brief counseling by physicians in medical settings. 7,8 Of note, as would be the case for heart disease or gastrointestinal disease, a single lecture or review article such as this one cannot even briefly mention all known efficacious addiction treatments, and certainly cannot provide detailed indications, prescribing information, and counseling ingredients. As a result, this article focuses on principles and the best proven treatments, particularly those of relevance to those who are not addiction physicians or counselors. How Effective Is Treatment? At 1 year, two-thirds of patients have a reduction in alcohol consequences (injury, unemployment) and consumption (by 50%). 9 One-third are abstinent or drinking moderately without consequences. Monetary benefits of alcohol and drug treatment to society outweigh costs 4-12-fold (depending on drug and treatment type). For opioid dependence, pharmacotherapy and counseling can achieve abstinence rates of 60-80%. Principles of Treatment The National Institute on Drug Abuse has published 13 principles of effective treatment. 10 These are:

3 TREATMENT OF ALCOHOL AND DRUG DEPENDENCE S61 1. No single treatment is appropriate for all individuals. Treatments should be individualized according to patient needs. 2. Treatment needs to be readily available. Patients ready for treatment can be lost if treatment is not immediately accessible. 3. Effective treatment attends to multiple needs of the individual, not just his or her drug use. These needs include addressing substance use and any associated medical, psychological, social, vocational, and legal problems. 4. As with any chronic illness, an individual s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person s changing needs. 5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The appropriate duration for an individual depends on the problems and needs but is usually at least 3 months. Treatment should include strategies to keep patients in treatment. 6. Counseling (individual and/or group) and other behavioral therapies are critical components of effective treatment for addiction. These therapies address motivation, problem solving, relationships, social functioning, and skills useful for avoiding drug use. 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. 8. Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. 9. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. 10. Treatment does not need to be voluntary to be effective. Mandated treatment can increase treatment entry and retention. 11. Possible drug use during treatment must be monitored continuously, with results presented to patients. Monitoring helps patients resist urges to use substances, and positive results can signal a need to intensify treatment. 12. Treatment programs should provide assessment for HIV acquired immunodeficiency syndrome, hepatitis B and C, tuberculosis, and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection. 13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment, or long-term treatment. Behavioral Treatments Behavioral treatments for addiction with proven efficacy are not simply generic counseling sessions. A number of therapies with specific content and doses, often clearly laid out in manuals, have been proven effective in well-designed studies. Motivational interviewing (or manualized 4-session motivational enhancement therapy) is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Cognitive behavioral therapies emphasize skills to cope with situations that might precipitate substance use. Twelve-step facilitation emphasizes the disease model of addiction and encourages and facilitates full participation in 12-step groups like Alcoholics Anonymous. Contingency management (sometimes referred to as involving motivational incentives) provides rewards for treatment adherence or negative drug testing results. Marital and family therapy can also be effective treatments for addiction. In the context of medication prescription for alcohol dependence, medical management by patients physicians, physician assistants, or nurses, a relatively brief form of repeated counseling similar to what medical physicians routinely do for other medications, appears to effective. 3 Medical management involves asking about medication side effects and adherence, and encouraging abstinence. A number of other behavioral treatments have proven efficacy. These include but are not limited to the following: relapse prevention counseling, supportive-expressive psychotherapy, individualized drug counseling, behavioral therapy for adolescents, multidimensional family therapy for adolescents, multisystemic therapy, community reinforcement approach plus vouchers, voucher-based reinforcement therapy in methadone maintenance treatment, day treatment with abstinence contingencies and vouchers, and the Matrix model. The details of these and other treatments are beyond the scope of this article. Pharmacological Treatments Pharmacological treatments for opioid dependence include methadone maintenance, buprenorphine, and naltrexone. 11 As with other pharmacotherapies, drug use should be monitored, and patients should participate in counseling and obtain any needed social support. Naltrexone is a synthetic opioid antagonist that blocks the euphoria associated with opioid use. To avoid precipitating withdrawal, it is given after an opiate-free period, and it is given daily or 3 times a week. It does not prevent craving, and nonadherence is common. This medication is best used in patients who are highly motivated to maintain abstinence (such as impaired physicians or people on parole) who receive counseling and careful monitoring. Methadone is a long-acting opioid agonist taken orally. 12,13 To be effective, it must be given over a long period of time at a dose sufficient to prevent withdrawal, block effects of illicit use, and decrease craving (generally 60 mg once a day). Patients stabilized on doses of methadone do not experience any euphoria from taking the drug; they feel normal and can function normally (or as normal as someone not receiving psychoactive medication can feel). In the United States, methadone can only be prescribed as a treatment for

4 S62 SAITZ opioid dependence by physicians in licensed methadone maintenance programs or by physicians with specific permission to prescribe it as office-based opioid therapy, currently an unusual exception. In these programs, to which access is limited, patients tend to be subject to stigma and to inconvenient and even punitive rules, such as needing to present daily at a particular time for dosing. Nonetheless, as part of a comprehensive drug treatment program, methadone treatment increases survival, increases treatment retention, decreases illicit opioid use, decreases hepatitis and HIV seroconversion, decreases criminal activity, increases employment, and improves birth outcomes. As with detoxification, 80% of patients who undergo treatment will relapse to illicit opioid use in a year. Of note, methadone is also an excellent choice for short-term prevention of withdrawal in general hospital settings. The goal of methadone treatment in those settings is to allow the treatment of the underlying medical or surgical condition. In these cases, the dose is mg in 24 hours, usually initially provided as mg followed by an additional 5-10 mg after 2-3 hours, until symptoms of withdrawal abate. Buprenorphine is a partial opioid agonist provided sublingually for maintenance. 14 With the exception of pregnant women, patients should be treated with a combination tablet of buprenorphine and naloxone. Naloxone is a short-acting opioid antagonist that is not absorbed sublingually but that prevents the tablets from being abused intravenously because it would precipitate withdrawal. Buprenorphine itself can precipitate withdrawal, so induction involves waiting for marked withdrawal symptoms (from the abused opioid) to appear, after which buprenorphine can be initiated at a low dose, then titrated higher to the usual maintenance doses of 8-16 mg once daily. Buprenorphine is quite safe, in part because the opioid effect has a ceiling: after a certain dose, no additional effect accrues. Although experience with buprenorphine is more limited than that with methadone, clinical trials have found that buprenorphine increases abstinence from illicit opioids, increases retention in treatment, and decreases opioid craving and even mortality. Some patients maintained on methadone can be switched to buprenorphine. Those less likely to succeed on buprenorphine are those requiring higher doses of methadone or requiring more structured treatment programs. Pharmacological treatments for alcohol dependence include disulfiram, acamprosate, naltrexone, and longacting injectable naltrexone. These medications reduce heavy drinking and increase abstinence. Disulfiram, an inhibitor of aldehyde dehydrogenase, results in increased levels of acetaldehyde and an unpleasant reaction after consumption of ethanol. The usual oral daily dose is 500 mg. In one of the largest studies of this medication, disulfiram was no better than placebo in achieving abstinence. But it is not clear whether a placebo-controlled trial is the best way to test a drug whose efficacy depends largely on the patient knowing that they may experience a very unpleasant reaction. Of note, in post hoc analyses, the drug was more effective in those who were adherent to it. In at least 5 controlled studies, disulfiram was associated with marked increases in abstinence when administration of the drug was supervised by a concerned other. Disulfiram has numerous contraindications, and the risk-benefit ratio for people at risk of complications should they experience the ethanol reaction (e.g., those with esophageal varices) needs to be considered. High doses can lead to an idiosyncratic fulminant hepatitis and neuropathy. Acamprosate increases continuous abstinence at 1 year by 8%, from 15% to 23%, and increases abstinent days by 27 days. 15 The mechanism of action is unclear, but the drug appears to work by affecting the glutamate system. The usual oral dose is 666 mg 3 times daily. The main side effect is diarrhea, which subsides with continued use, and the medication needs adjustment for renal insufficiency (and is contraindicated in patients with renal failure). Naltrexone decreases relapse to heavy drinking by approximately 11% (decrease in absolute risk from 48% to 37%). 15 Naltrexone is a long-acting opioid antagonist that is absorbed when taken orally. The usual dose is 50 mg daily. The medication blocks endogenous opioids, thus decreasing the reinforcing pleasurable effects of drinking. The main side effects, nausea and dizziness, subside with continued use. Naltrexone cannot be given to patients with opioid dependence or a need for opioids. In the event of an acute need for opioids to treat pain, naltrexone should be discontinued, and in the short term, very high doses of opioids will be required under close monitoring. Monthly injections of naltrexone (380 mg intramuscularly), as established by a placebo-controlled trial, also decreases heavy drinking, and may address the problems with adherence that occur with oral pharmacotherapies that need to be provided daily or more frequently. 4 The manufacturer has a program that coordinates product delivery for all patients being treated and provides information regarding appropriate storage and administration. Most studies of pharmacotherapies have been in patients who have completed detoxification first, but naltrexone appears to be efficacious even in patients who have a short duration of abstinence before beginning treatment. Of course, abstinence must be achieved before beginning disulfiram to avoid the disulfiram-ethanol reaction. During naltrexone or disulfiram treatment, liver enzymes should be monitored periodically. Although the drugs can cause increases in liver enzymes, most studies of alcohol dependence pharmacotherapy find decreases or no difference in levels in treated patients compared with control patients. All alcohol-dependence pharmacotherapies are category C; they should only be prescribed during pregnancy if risks will clearly outweigh benefits. Combinations of naltrexone and acamprosate do not appear to offer clear additional efficacy compared with either drug alone. For dependence on drugs other than alcohol, tobacco, and opioids, there are no well-established pharmacotherapies, although many are under investigation.

5 TREATMENT OF ALCOHOL AND DRUG DEPENDENCE S63 CO-OCCURRING MENTAL HEALTH CONDITIONS Diagnosis of co-occurring mental health problems can be challenging in people with addictions because there is substantial overlap in symptoms, and sometimes the temporal relations are difficult to sort out. Nonetheless, patients with co-occurring mental health conditions should have the conditions treated, regardless of whether the condition preceded the addiction or not. Psychiatric illness can interfere with adherence to and participation in addiction treatment, and it can trigger relapse. Psychiatric treatment can decrease these effects. For example, for those with anxiety disorders, buspirone can decrease heavy alcohol consumption. Fluoxetine is similarly effective in those with alcohol dependence and major depression. ADDRESSING ADDICTION What Is Risky and Problem Use? Excessive use of alcohol (e.g., 14 standard drinks per week or 4 drinks per occasion by men, 7 and 3 for women and the elderly) and use of drugs by people who do not meet criteria for substance dependence is more common than addiction. Problem use describes people who are using substances (or drinking heavily) and experiencing consequences of that use but who do not meet dependence criteria. People with risky use have not yet experienced consequences but are at risk (e.g., excessive alcohol use, any illicit drug use). How Can Risky and Problem Use Be Identified? Risky and problem use should be identified because brief intervention has efficacy (proven for alcohol, some evidence for efficacy for drug use), and because the prevalence is higher than that of dependence. Brief intervention can prevent future use and can likely decrease consequences. Screening tests can identify risky and problem use, and all adults should be screened. A single question can identify risky alcohol use: How many times in the past year have you had 5 (4 for women) or more drinks in a day? (a positive test is one or more times). Although screening tests are less well validated for drug use, several questionnaires have been developed, and a consensus panel recommended the following single question as a screening test: Have you ever used street drugs more than 5 times in your life? Longer screening questionnaires include the Alcohol Use Disorders Identification Test, a 2-item conjoint (drug and alcohol) screening test, the World Health Organization Alcohol Smoking and Substance Involvement Screening Test. Laboratory tests are generally insensitive and nonspecific when used for screening for unhealthy alcohol use. Laboratory testing for drug use is similarly not very useful for screening patients because of short half-lives and the need to test for many drugs of abuse. Brief Intervention Brief intervention generally refers to minutes of counseling, with feedback about use, advice, and goal setting, and follow-up contact with a clinician. The advice should be appropriate to the patient s readiness to change. Randomized trials in diverse clinical settings have found that brief interventions can reduce risky drinking amounts by 11%. Decreased heroin and cocaine use may result from brief intervention. 16 Although not consistently found in controlled studies, brief intervention may also decrease consequences of alcohol and other drug use, including serum gammaglutamyltransferase levels, hospitalization, and death. Most People With Addictions Do Not Receive Treatment Most people with addictions do not receive effective treatment. Most are not identified in medical settings. Even when patients with addictions are identified in medical settings, they often do not receive any efficacious interventions. And even when patients enter addiction care via detoxification, the initial steps are most often not followed by efficacious addiction treatment. For example, 80% of people with opioid addiction do not receive medication-assisted treatment. Screening and Brief Intervention Clinicians who are not addiction specialists can play critical roles in improving identification and management of patients with addictions. Universal screening can identify patients with addictions. Brief interventions can reduce substance use and/or recommend linkage to addictions care. Follow-up and support of specialty addiction treatment plans can contribute to relapse prevention efforts. 1 Referral to Mutual Help Groups Mutual or self-help groups such as Alcoholics Anonymous (AA) provide social support and an alcohol- and drug-free social network. Observational studies suggest that AA can increase abstinence for people with alcohol dependence who participate. Clinicians can refer patients to these groups, and they can help by suggesting that patients try groups until they find one they are comfortable with, and by asking about meeting attendance and participation. 1 Pharmacotherapy for Alcohol Dependence Clinicians who are not addiction specialists can become familiar with prescribing pharmacotherapies for alcohol dependence, and can then do so while having addiction specialists manage the many other interventions needed for successful addiction treatment (e.g., counseling, assistance with employment or housing). Buprenorphine Clinicians who are not addiction specialists can also become familiar with prescribing buprenorphine for opioid

6 S64 SAITZ dependence and prescribe this treatment. In the United States, a waiver is required from the Drug Enforcement Administration. 17,18 Obtaining the waiver requires certification in addiction medicine or psychiatry, or evidence of training (at least 8 hours) specifically acceptable for this purpose. Then, as with pharmacotherapy for alcohol dependence, the clinician can prescribe, knowing that other aspects of addiction treatment are addressed either in their practice or by addiction specialty clinicians or programs. Prescribing this effective opioid treatment in a medical office represents a dramatic contrast with the requirement to attend a program to receive methadone. Buprenorphine has the potential to be more accessible to patients than methadone because it can be prescribed in a doctor s office. Access is currently limited in the United States by the numbers of physicians prescribing this treatment and by a regulatory limit of 30 patients per physician, which can be increased to 100 after the first year. Integrating Care Clinicians who are not addiction specialists can help patients receive the care that they need over time. Patients with addictions often require coordinated, integrated care for addiction, mental health, and medical problems. These services are often delivered in different places by different clinicians, in short-term programs, leading to fragmented, uncoordinated care, and increasing the risk of errors and suboptimal care. Attention to the whole clinical picture and monitoring of all of the care received (e.g., case management) can improve care. Systems that integrate medical, addiction, and psychiatric care have the potential to improve patient outcomes. CONCLUSIONS To manage addictions appropriately, one must recognize that alcohol and other drug dependence are chronic illnesses. As such, the focus should be on longterm management with the goal of relapse prevention. Continued treatment is associated with better outcome than short-term treatment. Behavioral treatments with proven efficacy include motivational enhancement and cognitive behavioral therapy, contingency management, less intense and less specialized medication management, and brief counseling interventions that have efficacy specifically for nondependent unhealthy alcohol use, and perhaps for initiating referral for care. Pharmacological treatments, usually in the context of counseling, also have proven efficacy. The best proven of these include acamprosate, naltrexone (oral and long-acting injectable), and disulfiram for alcohol dependence, and methadone and buprenorphine for opioid dependence. To avoid addressing only the most severely affected patients, attention needs to be directed to the larger proportion of patients with risky use to whom the largest number of health problems can be attributed. Care for addictions should include attention to psychiatric comorbidity. Clinicians who are not addiction specialists can play very important roles in addressing addiction by identifying patients with risky, problem, or dependent use; by providing brief counseling and prescribing efficacious medications; by addressing common comorbidities; and by referring to specialists when needed. BIBLIOGRAPHY 1. Friedmann PD, Saitz R, Samet JH. Management of adults recovering from alcohol or other drug problems. JAMA 1998;279: Saitz R. Unhealthy alcohol use. N Engl J Med 2005;352; Anton RF, O Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al, for the COMBINE Study Research Group. Effect of combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE Study: a randomized controlled trial. JAMA 2006;295: Garbutt JC, Kranzler HR, O Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, et al, for the Vivitrex Study Group. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 2005;293: McLellan AT. Have we evaluated addiction treatment correctly? Implications from a continuing care perspective. Addiction 2002;88: McLellan AT, O Brien CP, Lewis DL, Kleber HD. Drug addiction as a chronic medical illness: implications for treatment, insurance and evaluation. JAMA 2000;284: Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, et al. Effectiveness of brief alcohol interventions in primary care populations [review]. Cochrane Database Syst Rev 2007;(2):CD US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med 2004;140: Miller WR, Walters ST, Bennett ME. How effective is alcoholism treatment in the United States? J Stud Alcohol 2001;62: National Institute on Drug Abuse. National Institutes of Health. Principles of Addiction Treatment: A Research- Based Guide. NIH Publication Bethesda, MD: National Institutes of Health; O Connor PG, Fiellin DA. Pharmacologic treatment of heroin-dependent patients. Ann Intern Med 2000;133: Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York, NY: Springer-Verlag; Dole VP, Nyswander M. A medical treatment for diacetylmorphine (heroin) addiction: a clinical trial with methadone hydrochloride. JAMA 1965;193: Fiellin DA, O Connor PG. Office-based treatment of opioiddependent patients. N Engl J Med 2002;347: Carmen B, Angeles M, Ana M, Maria AJ. Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction 2004;99: Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend 2005;77: Fiellin DA, O Connor PG. New federal initiatives to enhance the medical treatment of opioid dependence. Ann Intern Med 2002;137: Fiellin DA et al. Consensus statement on office-based treatment of opioid dependence using buprenorphine. J Substance Abuse Treat 2004;27:

DrugFacts: Treatment Approaches for Drug Addiction

DrugFacts: Treatment Approaches for Drug Addiction DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call the

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)

More information

Medication-Assisted Addiction Treatment

Medication-Assisted Addiction Treatment Medication-Assisted Addiction Treatment Molly Carney, Ph.D., M.B.A. Executive Director Evergreen Treatment Services Seattle, WA What is MAT? MAT is the use of medications, in combination with counseling

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

The Results of a Pilot of Vivitrol: A Medication Assisted Treatment for Alcohol and Opioid Addiction

The Results of a Pilot of Vivitrol: A Medication Assisted Treatment for Alcohol and Opioid Addiction The Results of a Pilot of Vivitrol: A Medication Assisted Treatment for Alcohol and Opioid Addiction James H. Barger, MD SAPC Medical Director and Science Officer Desiree A. Crevecoeur-MacPhail, Ph.D.

More information

Using Drugs to Treat Drug Addiction How it works and why it makes sense

Using Drugs to Treat Drug Addiction How it works and why it makes sense Using Drugs to Treat Drug Addiction How it works and why it makes sense Jeff Baxter, MD University of Massachusetts Medical School May 17, 2011 Objectives Biological basis of addiction Is addiction a chronic

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction [NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call

More information

Care Management Council submission date: August 2013. Contact Information

Care Management Council submission date: August 2013. Contact Information Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing

More information

Treatment of opioid use disorders

Treatment of opioid use disorders Treatment of opioid use disorders Gerardo Gonzalez, MD Associate Professor of Psychiatry Director, Division of Addiction Psychiatry Disclosures I have no financial conflicts to disclose I will review evidence

More information

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal

More information

Policy #: 457 Latest Review Date: December 2010

Policy #: 457 Latest Review Date: December 2010 Effective for dates of service on or after January 1, 2015 refer to: https://www.bcbsal.org/providers/drugpolicies/index.cfm Name of Policy: Naltrexone (Vivitrol ) Injections Policy #: 457 Latest Review

More information

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT

Considerations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA

More information

Alcohol Overuse and Abuse

Alcohol Overuse and Abuse Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions

More information

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK

SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK National Institute on Drug Abuse SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK U.S. Department of Health and Human National Institutes of Health SEEKING DRUG ABUSE TREATMENT: KNOW WHAT TO ASK The goal

More information

Advances in Addiction Science and Treatment. Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014

Advances in Addiction Science and Treatment. Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014 Advances in Addiction Science and Treatment Mady Chalk, Ph.D., MSW Treatment Research Institute November, 2014 Treatment Research Research Institute, Institute, 20132012 Presentation 1. What is driving

More information

Opioid Treatment Services, Office-Based Opioid Treatment

Opioid Treatment Services, Office-Based Opioid Treatment Optum 1 By United Behavioral Health U.S. Behavioral Health Plan, California Doing Business as OptumHealth Behavioral Solutions of California ( OHBS-CA ) 2015 Level of Care Guidelines Opioid Treatment Services,

More information

Naltrexone and Alcoholism Treatment Test

Naltrexone and Alcoholism Treatment Test Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score

More information

CLINICAL POLICY Department: Medical Management Document Name: Vivitrol Reference Number: NH.PHAR.96 Effective Date: 03/12

CLINICAL POLICY Department: Medical Management Document Name: Vivitrol Reference Number: NH.PHAR.96 Effective Date: 03/12 Page: 1 of 7 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted

More information

Medications for Alcohol and Drug Dependence Treatment

Medications for Alcohol and Drug Dependence Treatment Medications for Alcohol and Drug Dependence Treatment Robert P. Schwartz, M.D. Medical Director Rschwartz@friendsresearch.org Friends Research Institute Medications for Alcohol Dependence Treatment Disulfiram

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY OF OPIATE USE Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months

More information

Identification, treatment and support for individuals with Alcohol & Drug Addiction in the Community

Identification, treatment and support for individuals with Alcohol & Drug Addiction in the Community Identification, treatment and support for individuals with Alcohol & Drug Addiction in the Community Dr David Jackson Clinic Medical Officer The Hobart Clinic Association Drugs In tonight s context, drugs

More information

Beyond SBIRT: Integrating Addiction Medicine into Primary Care

Beyond SBIRT: Integrating Addiction Medicine into Primary Care Beyond SBIRT: Integrating Addiction Medicine into Primary Care Community Clinic Association of Los Angeles County 14 th Annual Health Care Symposium March 6, 2015 Keith Heinzerling MD, Karen Lamp MD; Allison

More information

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx Alcohol Abuse By Neva K.Gulsby, PA-C, and Bonnie A. Dadig, EdD, PA-C Posted on: April 18, 2013 Excessive

More information

Understanding Addiction: The Intersection of Biology and Psychology

Understanding Addiction: The Intersection of Biology and Psychology Understanding Addiction: The Intersection of Biology and Psychology Robert Heimer, Ph.D. Yale University School of Public Health Center for Interdisciplinary Research on AIDS New Haven, CT, USA November

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PDP IBT Inj - Vivitrol Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Opiate Antagonist Client: 2007 PDP IBT Inj Approval Date: 2/20/2007

More information

How To Treat A Drug Addiction

How To Treat A Drug Addiction 1 About drugs Drugs are substances that change a person s physical or mental state. The vast majority of drugs are used to treat medical conditions, both physical and mental. Some, however, are used outside

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone )

Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Treatment of Opioid Dependence with Buprenorphine/Naloxone (Suboxone ) Elinore F. McCance-Katz, M.D., Ph.D. Professor and Chair, Addiction Psychiatry Virginia Commonwealth University Neurobiology of Opiate

More information

Update on Buprenorphine: Induction and Ongoing Care

Update on Buprenorphine: Induction and Ongoing Care Update on Buprenorphine: Induction and Ongoing Care Elizabeth F. Howell, M.D., DFAPA, FASAM Department of Psychiatry, University of Utah School of Medicine North Carolina Addiction Medicine Conference

More information

Neurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011

Neurobiology and Treatment of Opioid Dependence. Nebraska MAT Training September 29, 2011 Neurobiology and Treatment of Opioid Dependence Nebraska MAT Training September 29, 2011 Top 5 primary illegal drugs for persons age 18 29 entering treatment, % 30 25 20 15 10 Heroin or Prescription Opioids

More information

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive.

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive. Heroin Introduction Heroin is a powerful drug that affects the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants to.

More information

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based

More information

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office

The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office The Federation of State Medical Boards 2013 Model Guidelines for Opioid Addiction Treatment in the Medical Office Adopted April 2013 for Consideration by State Medical Boards 2002 FSMB Model Guidelines

More information

Naltrexone for Opioid & Alcohol Use Disorders

Naltrexone for Opioid & Alcohol Use Disorders Naltrexone for Opioid & Alcohol Use Disorders Reid K. Hester, Ph.D. Director, Research Division Behavior Therapy Associates, LLC Senior Science Advisor Checkup and Choices, LLC 505.345.6100 reidkhester@gmail.com

More information

Minimum Insurance Benefits for Patients with Opioid Use Disorder The Opioid Use Disorder Epidemic: The Evidence for Opioid Treatment:

Minimum Insurance Benefits for Patients with Opioid Use Disorder The Opioid Use Disorder Epidemic: The Evidence for Opioid Treatment: Minimum Insurance Benefits for Patients with Opioid Use Disorder By David Kan, MD and Tauheed Zaman, MD Adopted by the California Society of Addiction Medicine Committee on Opioids and the California Society

More information

Patients are still addicted Buprenorphine is simply a substitute for heroin or

Patients are still addicted Buprenorphine is simply a substitute for heroin or BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute

More information

Use of Buprenorphine in the Treatment of Opioid Addiction

Use of Buprenorphine in the Treatment of Opioid Addiction Use of Buprenorphine in the Treatment of Opioid Addiction Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Executive Summary Which of the following is an

More information

Substance Abuse Treatment. Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence

Substance Abuse Treatment. Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence Spring 2007 Volume 6 Issue 1 ADVISORY News for the Treatment Field Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence What is naltrexone for extendedrelease injectable

More information

Presented by. 13 Principles 10/27/09. Principles of Drug Addiction Treatment: A Research Based Guide

Presented by. 13 Principles 10/27/09. Principles of Drug Addiction Treatment: A Research Based Guide Presented by Principles of Drug Addiction Treatment: A Research Based Guide Rick Moldenhauer, MS, LADC, ICADC, LPC Treatment Services Consultant, Alcohol and Drug Abuse Division PO Box 64977, St Paul,

More information

UCLA-SAPC Lecture Series March 13, 2015. Gary Tsai, M.D. Medical Director Substance Abuse Prevention and Control

UCLA-SAPC Lecture Series March 13, 2015. Gary Tsai, M.D. Medical Director Substance Abuse Prevention and Control UCLA-SAPC Lecture Series March 13, 2015 Gary Tsai, M.D. Medical Director Substance Abuse Prevention and Control Neurobiology 101 Neuroscience of Addiction & Recovery Medication-Assisted Treatment (MAT)

More information

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery

Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Death in the Suburbs: How Prescription Painkillers and Heroin Have Changed Treatment and Recovery Marvin D. Seppala, MD Chief Medical Officer Hazelden Betty Ford Foundation This product is supported by

More information

Medications for Alcohol and Opioid Use Disorders

Medications for Alcohol and Opioid Use Disorders Medications for Alcohol and Opioid Use Disorders Andrew J. Saxon, M.D. Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Health Care System Alcohol Pharmacotherapy

More information

Objectives: Perform thorough assessment, and design and implement care plans on 12 or more seriously mentally ill addicted persons.

Objectives: Perform thorough assessment, and design and implement care plans on 12 or more seriously mentally ill addicted persons. Addiction Psychiatry Program Site Specific Goals and Objectives Addiction Psychiatry (ADTU) Goal: By the end of the rotation fellow will acquire the knowledge, skills and attitudes required to recognize

More information

Heroin Overdose Trends and Treatment Options. Neil A. Capretto, D.O., F.A.S.A.M. Medical Director

Heroin Overdose Trends and Treatment Options. Neil A. Capretto, D.O., F.A.S.A.M. Medical Director Heroin Overdose Trends and Treatment Options Neil A. Capretto, D.O., F.A.S.A.M. Medical Director Type date here www.gatewayrehab.org Drug Overdose Deaths Increasing in Allegheny County Roberta Lojak holds

More information

I am here as a proponent of HB 384-Comprehensive Mental Health Parity.

I am here as a proponent of HB 384-Comprehensive Mental Health Parity. Mr. Chairman and Members of the Insurance Committee. My name is Dr. Gregory Brigham; I am a Licensed and Board Certified Clinical Psychologist. My wife, children and, grandchildren live, work and, attend

More information

OVERVIEW OF MEDICATION ASSISTED TREATMENT

OVERVIEW OF MEDICATION ASSISTED TREATMENT Sarah Akerman MD Assistant Professor of Psychiatry Director of Addiction Services Geisel School of Medicine/Dartmouth-Hitchcock Medical Center OVERVIEW OF MEDICATION ASSISTED TREATMENT Conflicts of Interest

More information

1. According to recent US national estimates, which of the following substances is associated

1. According to recent US national estimates, which of the following substances is associated 1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates

More information

Office-based Treatment of Opioid Dependence with Buprenorphine

Office-based Treatment of Opioid Dependence with Buprenorphine Office-based Treatment of Opioid Dependence with Buprenorphine David A. Fiellin, M.D Professor of Medicine, Investigative Medicine and Public Health Yale University School of Medicine Dr. Fiellin s Disclosures

More information

Drug Addiction Is a Disease So What Do We Do about It?

Drug Addiction Is a Disease So What Do We Do about It? Drug Addiction Is a Disease So What Do We Do about It? L E S S O N 5 Elaborate/Evaluate Photo courtesy of Gray Wolf Ranch Wilderness Recovery Lodge. Overview Students make predictions about the success

More information

California Society of Addiction Medicine (CSAM) Consumer Q&As

California Society of Addiction Medicine (CSAM) Consumer Q&As C o n s u m e r Q & A 1 California Society of Addiction Medicine (CSAM) Consumer Q&As Q: Is addiction a disease? A: Addiction is a chronic disorder, like heart disease or diabetes. A chronic disorder is

More information

Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center

Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center 1 in 4 Americans will have an alcohol or drug problems at some point in their lives. The number of alcohol abusers and addicts

More information

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769.

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769. Diagnosis and Treatment of Alcohol Dependence Lon R. Hays, MD, MBA Professor and Chairman Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink = 14

More information

On-line Continuing Education. Course Material: Exam Questions Packet

On-line Continuing Education. Course Material: Exam Questions Packet BREINING INSTITUTE 8894 Greenback Lane Orangevale, California USA 95662-4019 Telephone (916) 987-2007 Facsimile (916) 987-8823 On-line Continuing Education Course Material and Exam Questions Packet Course

More information

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective

Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Treatment and Interventions for Opioid Addictions: Challenges From the Medical Director s Perspective Dale K. Adair, MD Medical Director/Chief Psychiatric Officer OMHSAS 1 Treatment and Interventions for

More information

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in 1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage withdrawal during detoxification, stabilisation and substitution as well as for relapse prevention,

More information

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769.

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769. Diagnosis and Treatment of Alcohol Dependence Lon R. Hays, MD, MBA Professor and Chairman an Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink

More information

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings

Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings Integrating Medication- Assisted Treatment (MAT) for Opioid Use Disorders into Behavioral and Physical Healthcare Settings All-Ohio Conference 3/27/2015 Christina M. Delos Reyes, MD Medical Consultant,

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

Dependence and Addiction. Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania

Dependence and Addiction. Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania Dependence and Addiction Marek C. Chawarski, Ph.D. Yale University David Metzger, Ph.D. University of Pennsylvania Overview Heroin and other opiates The disease of heroin addiction or dependence Effective

More information

These changes are prominent in individuals with severe disorders, but also occur at the mild or moderate level.

These changes are prominent in individuals with severe disorders, but also occur at the mild or moderate level. Substance-Related Disorders DSM-V Many people use words like alcoholism, drug dependence and addiction as general descriptive terms without a clear understanding of their meaning. What does it really mean

More information

Scientific Facts on. Psychoactive Drugs. Tobacco, Alcohol, and Illicit Substances

Scientific Facts on. Psychoactive Drugs. Tobacco, Alcohol, and Illicit Substances page 1/5 Scientific Facts on Psychoactive Drugs Tobacco, Alcohol, and Illicit Substances Source document: WHO (2004) Summary & Details: GreenFacts Context - Psychoactive drugs such as tobacco, alcohol,

More information

IN THE GENERAL ASSEMBLY STATE OF. Ensuring Access to Medication Assisted Treatment Act

IN THE GENERAL ASSEMBLY STATE OF. Ensuring Access to Medication Assisted Treatment Act IN THE GENERAL ASSEMBLY STATE OF Ensuring Access to Medication Assisted Treatment Act 1 Be it enacted by the People of the State of Assembly:, represented in the General 1 1 1 1 Section 1. Title. This

More information

Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction

Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction Frequently Asked Questions (FAQ s): Medication-Assisted Treatment for Opiate Addiction March 3, 2008 By: David Rinaldo, Ph.D., Managing Partner, The Avisa Group In this FAQ What medications are currently

More information

DSM-IV Alcohol Dependence. Alcohol and Drug Abuse. Screening for Alcohol Risk. DSM-IV Alcohol Abuse

DSM-IV Alcohol Dependence. Alcohol and Drug Abuse. Screening for Alcohol Risk. DSM-IV Alcohol Abuse DSM-IV Alcohol Dependence Alcohol and Drug Abuse David Gilder, MD Division of Mental Health Scripps Clinic Alcohol Research Center The Scripps Research Institute 1.5.11 Three or more criteria, same 12

More information

Developing Medications to Treat Addiction: Implications for Policy and Practice. Nora D. Volkow, M.D. Director National Institute on Drug Abuse

Developing Medications to Treat Addiction: Implications for Policy and Practice. Nora D. Volkow, M.D. Director National Institute on Drug Abuse Developing Medications to Treat Addiction: Implications for Policy and Practice Nora D. Volkow, M.D. Director National Institute on Drug Abuse Medications Currently Available For Nicotine Addiction Nicotine

More information

What is Addiction and How Do We Treat It? Roger D. Weiss, M.D. Professor of Psychiatry, Harvard Medical School Clinical Director, Alcohol and Drug

What is Addiction and How Do We Treat It? Roger D. Weiss, M.D. Professor of Psychiatry, Harvard Medical School Clinical Director, Alcohol and Drug What is Addiction and How Do We Treat It? Roger D. Weiss, M.D. Professor of Psychiatry, Harvard Medical School Clinical Director, Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA

More information

Strategies for Addressing Alcohol Dependence

Strategies for Addressing Alcohol Dependence Strategies for Addressing Alcohol Dependence Jennifer McNeely, MD, MS Assistant Professor NYU School of Medicine Disclosures No relevant financial relationships to disclose Current research grant support:

More information

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION

MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Sidarth Wakhlu,M.D. Addiction Team Leader North Texas VA Health Care System Addiction Psychiatry Fellowship Director Associate Professor Of Psychiatry

More information

Medication-Assisted Treatment for Opiate Addiction and the Public Financing of that Treatment

Medication-Assisted Treatment for Opiate Addiction and the Public Financing of that Treatment Medication-Assisted Treatment for Opiate Addiction and the Public Financing of that Treatment Introduction March 3, 2008 By: Suzanne Gelber, MSW, Ph.D., Managing Partner, The Avisa Group Defining Characteristics

More information

Medication for the Treatment of Alcohol Use Disorder. Pocket Guide

Medication for the Treatment of Alcohol Use Disorder. Pocket Guide Medication for the Treatment of Alcohol Use Disorder Pocket Guide Medications are underused in the treatment of alcohol use disorder. According to the National Survey on Drug Use and Health, of the estimated

More information

Addressing Substance and Alcohol Use Prior to HCV Treatment

Addressing Substance and Alcohol Use Prior to HCV Treatment Addressing Substance and Alcohol Use Prior to HCV Treatment Glenn J. Treisman, MD, PhD The Johns Hopkins University School of Medicine Baltimore, Maryland Disclosure Information Dr Treisman has no relevant

More information

Treatment of Prescription Opioid Dependence

Treatment of Prescription Opioid Dependence Treatment of Prescription Opioid Dependence Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse McLean Hospital, Belmont, MA Professor of Psychiatry, Harvard Medical School, Boston, MA Prescription

More information

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION

TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION TENNESSEE BOARD OF MEDICAL EXAMINERS POLICY STATEMENT OFFICE-BASED TREATMENT OF OPIOID ADDICTION The Tennessee Board of Medical Examiners has reviewed the Model Policy Guidelines for Opioid Addiction Treatment

More information

Impact of Systematic Review on Health Services: The US Experience

Impact of Systematic Review on Health Services: The US Experience Impact of Systematic Review on Health Services: The US Experience Walter Ling MD Integrated Substance Abuse Programs (ISAP) UCLA The effectiveness of interventions for addictions: The Drug and Alcohol

More information

Buprenorphine Therapy in Addiction Treatment

Buprenorphine Therapy in Addiction Treatment Buprenorphine Therapy in Addiction Treatment Ken Roy, MD, FASAM Addiction Recovery Resources, Inc. River Oaks Hospital Tulane Department of Psychiatry www.arrno.org Like Minded Doc What is MAT? Definition

More information

Dartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft***

Dartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft*** Dartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft*** This content, sorted by LCME competencies is intended to

More information

In 2010, approximately 8 million Americans 18 years and older were dependent on alcohol.

In 2010, approximately 8 million Americans 18 years and older were dependent on alcohol. Vivitrol Pilot Study: SEMCA/Treatment Providers Collaborative Efforts with the treatment of Opioid Dependent Clients Hakeem Lumumba, PhD, CAADC SEMCA Scott Schadel, MSW, LMSW, CAADC HEGIRA PROGRAMS, INC.

More information

Alcohol Addiction. Introduction. Overview and Facts. Symptoms

Alcohol Addiction. Introduction. Overview and Facts. Symptoms Alcohol Addiction Alcohol Addiction Introduction Alcohol is a drug. It is classed as a depressant, meaning that it slows down vital functions -resulting in slurred speech, unsteady movement, disturbed

More information

A Drug Policy for the 21st Century. Office of National Drug Control Policy

A Drug Policy for the 21st Century. Office of National Drug Control Policy A Drug Policy for the 21st Century October 18, 2014 International Nurses Society on Addictions Health Care Reform & Its Impact on Addictions Nursing: Navigating Change through the Rapids David K. Mineta,

More information

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013

Hulpverleningsmodellen bij opiaatverslaving. Frieda Matthys 6 juni 2013 Hulpverleningsmodellen bij opiaatverslaving Frieda Matthys 6 juni 2013 Prevalence The average prevalence of problem opioid use among adults (15 64) is estimated at 0.41%, the equivalent of 1.4 million

More information

Suboxone Programs: Treating Opioid Dependence in CHCs Andrew Putney, MD Medical Director SSTAR ATS and CHC, Fall River, Massachusetts

Suboxone Programs: Treating Opioid Dependence in CHCs Andrew Putney, MD Medical Director SSTAR ATS and CHC, Fall River, Massachusetts Suboxone Programs: Treating Opioid Dependence in CHCs Andrew Putney, MD Medical Director SSTAR ATS and CHC, Fall River, Massachusetts Educational Objectives: Review epidemiology of opioid addiction in

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

American Society of Addiction Medicine

American Society of Addiction Medicine American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

More information

Reintegration. Recovery. Medication-Assisted Treatment for Alcohol Dependence. Reintegration. Resilience

Reintegration. Recovery. Medication-Assisted Treatment for Alcohol Dependence. Reintegration. Resilience Reintegration Recovery Medication-Assisted Treatment for Alcohol Dependence Reintegration Resilience 02 How do you free yourself from the stress and risks of alcohol dependence? Most people cannot do it

More information

Core Competencies for Addiction Medicine, Version 2

Core Competencies for Addiction Medicine, Version 2 Core Competencies for Addiction Medicine, Version 2 Core Competencies, Version 2, was approved by the Directors of the American Board of Addiction Medicine (ABAM) Foundation March 6, 2012 Core Competencies

More information

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma Background A growing opiate abuse epidemic has highlighted the need for effective treatment options. This study documents

More information

Assessment and Diagnosis of DSM-5 Substance-Related Disorders

Assessment and Diagnosis of DSM-5 Substance-Related Disorders Assessment and Diagnosis of DSM-5 Substance-Related Disorders Jason H. King, PhD (listed on p. 914 of DSM-5 as a Collaborative Investigator) j.king@lecutah.com or 801-404-8733 www.lecutah.com D I S C L

More information

How To Treat Anorexic Addiction With Medication Assisted Treatment

How To Treat Anorexic Addiction With Medication Assisted Treatment Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious

More information

Overview of Chemical Addictions Treatment. Psychology 470. Background

Overview of Chemical Addictions Treatment. Psychology 470. Background Overview of Chemical Addictions Treatment Psychology 470 Introduction to Chemical Additions Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides 1 Background Treatment approaches

More information

Applicant Webinar for BJA s Drug Court Discretionary Grant Solicitation

Applicant Webinar for BJA s Drug Court Discretionary Grant Solicitation Applicant Webinar for BJA s Drug Court Discretionary Grant Solicitation Cynthia Caporizzo, Senior Criminal Justice Advisor, Office of National Drug Control Policy (ONDCP) - Review of the administration

More information

Ohio Legislative Service Commission

Ohio Legislative Service Commission Ohio Legislative Service Commission Bill Analysis Brian D. Malachowsky H.B. 378 130th General Assembly () Reps. Smith and Sprague BILL SUMMARY Prohibits a physician from prescribing or personally furnishing

More information

Resources for the Prevention and Treatment of Substance Use Disorders

Resources for the Prevention and Treatment of Substance Use Disorders Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug

More information

DEVELOPING MANUFACTURING SUPPLYING. Naltrexone Implants. Manufactured by NalPharm Ltd WWW.NALPHARM.COM

DEVELOPING MANUFACTURING SUPPLYING. Naltrexone Implants. Manufactured by NalPharm Ltd WWW.NALPHARM.COM DEVELOPING MANUFACTURING SUPPLYING Naltrexone Implants Background to Nalpharm NalPharm is a specialist pharmaceutical company supplying proprietary branded medications and generic drugs in the area of

More information

Program Assistance Letter

Program Assistance Letter Program Assistance Letter DOCUMENT NUMBER: 2004-01 DATE: December 5, 2003 DOCUMENT TITLE: Use of Buprenorphine in Health Center Substance Abuse Treatment Programs TO: All Bureau of Primary Health Care

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

A G U I D E F O R U S E R S N a l t r e x o n e U

A G U I D E F O R U S E R S N a l t r e x o n e U A GUIDE FOR USERS UNaltrexone abstinence not using a particular drug; being drug-free. opioid antagonist a drug which blocks the effects of opioid drugs. dependence the drug has become central to a person

More information

Alcohol intervention programs in other countries

Alcohol intervention programs in other countries Alcohol intervention programs in other countries Assist. Prof. Dr. Suttiporn Janenawasin Siriraj Hosp. Mahidol Univ. A Major Task for Drug Treatment is Changing Brains Back! The Most Effective Treatment

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction

More information