substance_abuse | CARLAT PUBLISHING

Insomnia and Substance Use Disorders

April 10, 2019

Nicholas Rosenlicht, MD

Clinical Professor of Psychiatry, University of California, San Francisco, School of Medicine. Founder and served for 15 years as the director of the UCSF-VAMC Mood Disorders Clinic. Dr. Rosenlicht has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Sleep problems are common in recovery, and they have many causes such as withdrawal states, circadian rhythm disruptions, and a host of psychiatric and medical comorbidities. It’s a two-way street: Insomnia raises the risk of substance misuse, and addiction can cause or worsen sleep problems.

Coffee: Healthy Study Aid or the Addiction We Hate to Acknowledge?

January 1, 2019

Rehan Aziz, MD.

Rehan Aziz, MD. Associate professor of psychiatry and neurology, Rutgers Robert Wood Johnson School of Medicine. Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Caffeine permeates our society. It comes in many forms, including coffee and increasingly popular energy drinks. We consume it, and so do our patients. So, is it a harmless habit or a potentially harmful addiction? Let’s take a sip and find out.

Narcotics Anonymous: What to Tell Your Patients

November 8, 2018

Most of us are pretty familiar with Alcoholics Anonymous (AA), and asking about AA attendance and participation is routine during appointments with patients trying to curb their alcohol use. But what about Narcotics Anonymous (NA)?

Using Medical Management in Treating Opioid Use Disorder

November 8, 2018

Andrew Saxon, MD

Andrew Saxon, MD Professor, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Director, Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA. Chair, Council on Addiction Psychiatry. Dr. Saxon has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

To set the stage for understanding medical management, we need to go back about 20 years to the inception of the landmark COMBINE Study. This study was a very large clinical trial for alcohol use disorder (AUD) that compared naltrexone, acamprosate, and their combination, and also looked at two behavioral interventions.

Opioid Treatment Options

November 8, 2018

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing.

Is Cannabis Bad for Cognition?

November 1, 2018

Jessica Goren, PharmD, BCPP.

Jessica Goren, PharmD, BCPP. Dr. Goren has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Our patients typically tell us that, according to the internet, weed is perfectly safe and does not affect their ability to think or function. Thirty states and the District of Columbia have laws legalizing cannabis, supporting the notion that people have begun to think of marijuana as relatively harmless.

Alcohol Use Disorder Meds in Older Adults

October 1, 2018

Rehan Aziz, MD, FAPA

Rehan Aziz, MD, FAPA Associate Professor of Psychiatry and Neurology, Rutgers Robert Wood Johnson Medical School Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How should we employ pharmacotherapies for alcohol use disorder (AUD) in older adult patients? There are three FDA-approved medications (acamprosate, disulfiram, and naltrexone) and two other commonly used off-label agents (gabapentin and topiramate).

Substance Use Disorder in Older Adults

October 1, 2018

David Oslin, MD

David Oslin, MD Professor of Psychiatry, Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Medical Center Dr. Oslin has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

As we age, we are more vulnerable to a lot of things—the same amount of alcohol or the same amount of any of these substances is going to cause more impairment in an older person vs a younger one. As an example, our stability and gait can worsen as we get older, so any substance that affects gait or balance will have a larger effect.

Low-Risk Drinking Limits: What Should We Tell Older Adult Patients?

October 1, 2018

Thomas Jordan, MD, MPH

Thomas Jordan, MD, MPH Contributing writer to the Carlat newsletters Dr. Jordan has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

How much can our older patients safely drink? And what does “safe” or “low-risk” drinking actually mean? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which is the branch of the NIH that focuses on problems related to alcohol, has released guidelines for low-risk drinking limits in older patients.

Opioids Not Superior to Other Medicines for Some Chronic Pain

October 1, 2018

Rehan Aziz, MD

Rehan Aziz, MD Dr. Aziz has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Rising rates of opioid overdose deaths have sounded alarm bells over opioid prescribing practices for chronic pain. Unfortunately, and despite the absence of quality data on their risks vs benefits, long-term opioid management has remained a common approach to managing chronic musculoskeletal pain.