Opioid Related Disorders

The number of persons in the United States who take prescription opioids for pain is growing. Sullivan and colleagues2 found that from 2000 to 2005 there was a 19% increase in the number of patients who received prescriptions for opioids to manage chronic noncancer pain conditions. Based on a survey conducted from 1998 to 2006 with more than 19,000 subjects, Parsells Kelly and associates3 reported that 2% of the US population 18 years and older legally used opioids as analgesics at least 5 days per week for 4 or more weeks-and that another 2.9% used these drugs less frequently.

The leading edge of the baby boom generation is rapidly moving into the treatment realm of geriatric psychiatry. As a cohort, baby boomers experimented more with alcohol and illicit drugs than did previous generations.

Addiction-related prevention, research, and treatment have remained important areas of concentration in the field of psychiatry.

Bulimia nervosa is a disorder with a complex cause. The disorder is most commonly seen in women, generally with onset in adolescence.

In 2006, substance dependence or abuse was diagnosed in about 22.6 million persons in the United States.1 Addiction-related morbidity and mortality pose a major burden to society, costing our economy more than $500 billion annually: about $181 billion for illicit drugs,2 $168 billion for tobacco,3 and $185 billion for alcohol.4

The therapeutic challenges presented by comorbid psychiatric and substance abuse disorders, along with strategies and initiatives to improve treatment, were the focus of a recent collection of studies and reviews in the Journal of Substance Abuse Treatment.

Recent years have witnessed exciting developments in understanding and treating addictions. For example, it seems that almost weekly we get new insights into the neurobiology underlying vulnerability to addiction. Similarly, there have never been more medications available to treat the spectrum of addictive disorders, especially alcohol, nicotine, and opioid dependence. In addition, studies continue to underscore the crucial role of psychosocial treatments in recovery from addiction.

In my last column I used the ancient metaphor from Homer's Odyssey of being caught between the two monsters of Scylla and Charybdis to describe the predicament of contemporary physicians treating chronic pain.

Although methadone (Dolophine, Methadose) is primarily thought of as treatment for opioid addiction, it is also an excellent and underused analgesic. This column discusses the issues to consider when deciding whether to prescribe methadone for pain relief.

Marijuana is the most commonly used illicit drug in the United States and worldwide. Initiation of use typically occurs during adolescence. The most recent epidemiological data indicate that in the United States, 42% of high school seniors have tried marijuana, 18% have used it in the past 30 days, and 5% use it daily.

Up to 30% of patients for whom opioids are prescribed for chronic pain show an escalating pattern of opioid abuse characterized by taking more opioids than prescribed, seeking early refills, and finding additional sources of opioids. Although many of these drug-seeking patients are addicted to opioids, some are suffering not from addiction but from inadequate pain management, according to Martha Wunsch, MD, chair of Addiction Medicine and associate professor of pediatrics at Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg.

How do we help patients manage pain without exacerbating or reactivating an addictive disorder?

The connection between social policy and the treatment of addiction was the topic of several symposia at the 37th annual Medical-Scientific Conference of the American Society of Addiction Medicine (ASAM).

Proper evaluation of patients for alcohol and substance use disorders is usually time-consuming. When done in a busy emergency department (ED), assessment is often rushed, increasing the likelihood of misdiagnosis and, therefore, mismanagement. Because the evaluation is a patient's first step to effective therapy, it should be conducted as efficiently and effectively as possible.

With its focus on both behavior modification and mindfulness training, dialectical behavior therapy has proven quite effective in treating patients with borderline personality disorder. This article provides a primer on a modified version of this outpatient treatment for borderline patients with substance use disorders, a comorbid condition that may affect as many as two-thirds of patients with BPD.

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

Chronic infection with the hepatitis C virus (HCV) is frequently complicated by the presence of co-existing substance use disorders and mental illnesses. It is important to find improved ways to address barriers to care, and to provide effective and humane care to patients suffering from HCV infection.

Substance abuse and addiction are among the most challenging health problems facing our society. Breakthrough discoveries in science continue to refine our understanding of drug abuse and addiction and are yielding new opportunities to translate basic research findings into tangible treatment products. Read about the progress being made by the National Institute on Drug Abuse, the world's largest supporter of research on the health aspects of addiction.

When physicians struggle with substance use disorders, physician health programs are an important source of information and support. Certain medical specialties are at higher risk for substance use disorders than are others, and drugs of choice vary by specialty. Physician health and patient safety must be considered, but colleagues can help.

Smoking is not only a comorbid condition for schizophrenia; it may also have an effect on other psychiatric conditions.

Marc Schuckit, M.D., professor of psychiatry at the University of California, San Diego, School of Medicine, examined recent developments in the treatments for alcohol and drug dependence, and examined important changes in DSM-IV's classification of substance use disorder at the 11th Annual U.S. Psychiatric & Mental Health Congress.