You are evaluating a 16-year-old boy referred for mandated substance use treatment by his high school, where he was found drinking alcohol and smoking cannabis with a friend in the restroom.

Since they already often seem two steps ahead of us, with adolescents it can be really helpful to use direct routes. Be very specific in your questions. For example, don’t just ask, “Do you smoke?” Ask, “Are you using any nicotine products? What are you using in your vape?”

If we think of the molecules (the endorphins or the opioids) as “keys” and the receptors on the neurons as “locks,” then one needs the right key in the lock to get the reward—to turn on the good feelings.

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics.

Dosages matter. The risk of death from an overdose with patients prescribed at least 100 mg daily morphine equivalent is about 7 times higher than a patient prescribed less than 20 mg of morphine a day.

All pain is real. It’s just a question of whether that pain is being triggered by a physical injury or by something else. Studies show that emotional injury activates the same areas of the brain as does physical injury.

New evidence suggests that the prevalence of fetal alcohol spectrum disorder is higher than previously documented. In this study, prevalence estimates were derived from 13,146 first-grade children in four U.S. communities between 2010 and 2016.

Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)?

Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of methadone side effects.

Over the last few decades, doctors have done a better job at convincing their patients to stop smoking. But much of this improvement has been relegated to patients without mental illness.