Psychopharmacology for Substance Use Disorders

2021 ◽  
Author(s):  
Olapeju Simoyan ◽  
Krista Ulisse
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Maintenance Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Duration Of Symptoms ◽  
Stimulant Use

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder. This review contains 3 tables, and 31 references. Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal

Personality profiles of patients with alcohol use disorder and opioid use disorder in an inpatient treatment setting

2019 ◽  
Vol 97 ◽  
pp. 91-96 ◽  
Author(s):  
Jeffrey S. Nevid ◽  
Alexander J. Gordon ◽  
Ari Barris ◽  
Jacob E. Sperber ◽  
Gregory Haggerty
Keyword(s):  
Alcohol Use ◽  
Inpatient Treatment ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Treatment Setting ◽  
Personality Profiles ◽  
Opioid Use

Effectiveness and Availability of Treatment for Substance Use Disorders

2018 ◽  
Author(s):  
Dominic Hodgkin ◽  
Hilary S. Connery
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
The United States ◽  
Treatment Programs ◽  
Future Research ◽  
Dissemination And Implementation ◽  
Major Focus ◽  
Medication Treatment

Drug and alcohol use disorders, also called substance use disorders (SUD), are among the major health problems facing many countries, contributing a substantial burden in terms of mortality, morbidity, and economic impact. A considerable body of research is dedicated to reducing the social and individual burden of SUD. One major focus of research has been the effectiveness of treatment for SUD, with studies examining both medication and behavioral treatments using randomized, controlled clinical trials. For opioid use disorder, there is a strong evidence base for medication treatment, particularly using agonist therapies (i.e., methadone and buprenorphine), but mixed evidence regarding the use of psychosocial interventions. For alcohol use disorder, there is evidence of modest effectiveness for two medications (acamprosate and naltrexone) and for various psychosocial treatments, especially for less severe alcohol use disorder syndromes. An important area for future research is how to make treatment more appealing to clients, given that client reluctance is an important contributor to the low utilization of effective treatments. A second major focus of research has been the availability of medication treatments, building on existing theories of how innovations diffuse, and on the field of dissemination and implementation research. In the United States, this research identifies serious gaps in both the availability of SUD treatment programs and the availability of effective treatment within those programs. Key barriers include lack of on-site medical staff at many SUD treatment programs; restrictive policies of private insurers, states, and federal authorities; and widespread skepticism toward medication treatment among counseling staff and some administrators. Emerging research is promising for providing medication treatment in settings other than SUD treatment programs, such as community mental health centers, prisons, emergency departments, and homeless shelters. There is still considerable room to make SUD treatment approaches more effective, more available, and—most importantly—more acceptable to clients.

scholarly journals Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

2021 ◽  
Author(s):  
Celia Stafford ◽  
Wesley Marrero ◽  
Rebecca B. Naumann ◽  
Kristen Hassmiller Lich ◽  
Sarah Wakeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Geographic Region ◽  
Influential Factors ◽  
Opioid Use ◽  
Living Situation ◽  
Data Set ◽  
Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

Substance Use Disorders in the Elderly

2017 ◽  
Author(s):  
Michael Burgard ◽  
Robert Kohn
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorders ◽  
Alcohol Use Disorder ◽  
Illicit Drugs ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The United States ◽  
Driving Under The Influence

Substance use disorders in older adults remains lower than in younger adults; however, the prevalence is rising in the elderly population. In the United States, the lifetime prevalence of an alcohol use disorder among persons age 65 and older is 16.1%. Studies of Veteran’s Administration nursing home residents have found that 29% to 49% of those admitted have a lifetime diagnosis of alcohol use disorder. A sizable proportion of the elderly acknowledge driving under the influence. In 2013, 1.5% of the elderly had used illicit drugs. The number requiring treatment for substance abuse is expected to double by 2020. The populations with the fastest increase in opiate mortality are those age 55 and older, including those 65 and older. This chapter presents the epidemiology of substance use among older adults and discusses issues related to elders’ substance use, including use in nursing homes, impaired driving and arrests, use of non-prescription medications, screening for substance use, and treatment.

Need for and Receipt of Substance Use Disorder Treatment Among Adults, by Gender, in the United States

2021 ◽  
pp. 003335492110415
Author(s):  
Caitlin E. Martin ◽  
Anna Beth Parlier-Ahmad ◽  
Lori Beck ◽  
Anna Scialli ◽  
Mishka Terplan
Keyword(s):  
United States ◽  
Substance Use ◽  
Alcohol Use ◽  
Substance Use Disorder ◽  
Alcohol Use Disorder ◽  
White Women ◽  
Unmet Need ◽  
The United States ◽  
Treatment Need ◽  
Gender Specific

Objectives Disparities in substance use disorder (SUD) treatment use persist across groups, including gender. Using a gender-informed approach to expand treatment capacity and reduce barriers to treatment engagement is vital. We examined SUD treatment need and receipt among people with SUD in the United States, by gender, and assessed gender-specific sociodemographic factors associated with unmet need for SUD treatment and reported treatment barriers. Methods We conducted an analysis of data among adults aged ≥18 with a past-year SUD from the National Survey on Drug Use and Health (2015-2018). We computed population-adjusted frequencies and proportions for SUD treatment need and receipt and assessed gender differences. Multivariate logistic regression assessed gender-specific sociodemographic variables associated with SUD treatment receipt. Results Among adults with a past-year SUD, 63.4% were men and 36.6% were women ( P < .001), only 10.6% received SUD treatment, and a greater percentage of women than men needed treatment for opioid use disorder (11.9% vs 9.9%; P = .002). Receipt of SUD treatment was lowest among women with alcohol use disorder followed by men with alcohol use disorder (7.5% vs 8.9%; P = .052). Non-Latinx Black men had fewer than half the adjusted odds of receiving SUD treatment than non-Latinx White men (adjusted odds ratio [aOR] = 0.44; 95% CI, 0.27-0.71). Latinx women (aOR = 0.37; 95% CI, 0.18-0.73) and non-Latinx Black women (aOR = 0.51; 95% CI, 0.27-0.94) had significantly lower odds of receiving SUD treatment than non-Latinx White women. Conclusions As public health efforts target expanding SUD treatment capacity and addressing disparities in use of SUD treatment, interventions informed by gender and culture should be prioritized.

NIOSH Responds to the U.S. Drug Overdose Epidemic

2021 ◽  
pp. 104829112110407
Author(s):  
Jamie C. Osborne ◽  
L. Casey Chosewood
Keyword(s):  
United States ◽  
Substance Use ◽  
Drug Overdose ◽  
Drug Users ◽  
Illicit Drugs ◽  
Occupational Safety ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery “capital.” The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

Emergency department presentation of opioid use disorder and alcohol use disorder

2021 ◽  
pp. 108343
Author(s):  
Imam M. Xierali ◽  
Philip G. Day ◽  
Kurt C. Kleinschmidt ◽  
Chance Strenth ◽  
F. David Schneider ◽  
...  
Keyword(s):  
Emergency Department ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Emergency Department Presentation ◽  
Opioid Use

scholarly journals Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report

2017 ◽  
Vol 7 (6) ◽  
pp. 287-289
Author(s):  
Shuang Ouyang ◽  
Troy Moore
Keyword(s):  
Case Report ◽  
Alcohol Use Disorder ◽  
White Male ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Stimulant Use ◽  
Pubmed Search ◽  
Abuse Treatment ◽  
Overdose Deaths

Abstract Opioid overdose–related morbidity and mortality remain one of the most pressing public health crises. Overdose education and naloxone distribution have emerged as an effective initiative for mitigating overdose deaths. This case highlights areas of patient education essential to optimizing treatment outcome when using a naloxone reversal kit. The patient is a 46-year-old white male with a past medical history significant for opioid use disorder, alcohol use disorder, stimulant use disorder, sedative-hypnotic use disorder, and posttraumatic stress disorder. The patient received an intranasal naloxone kit during residential substance abuse treatment. Five months later, the patient requested a new kit and was asked about the disposition of his previous kit. The patient recounted how he was telephoned to pick up an unconscious friend (and fellow veteran) from a nonresidential location. Upon arrival, the patient recognized opioid products near his friend and took steps to reverse the suspected opioid overdose with his 2 mg/2 mL naloxone intranasal kit. The reversal was successful, but many critical rescue response steps were omitted. This case report may guide future changes to educating patients on appropriate responses to opioid overdoses with naloxone. A PubMed search located one other case report of successful naloxone reversal of opioid overdose in the veteran population, which involved fentanyl sold as heroin. In our case report, a veteran successfully used his naloxone kit to reverse a suspected opioid overdose in another veteran, but he incompletely provided the rescue response. This experience may influence content changes for future overdose education and naloxone distribution training.

scholarly journals Relapse rates among veterans on maintenance doses of combination buprenorphine and naloxone for opioid use disorder

2020 ◽  
Vol 10 (3) ◽  
pp. 80-84
Author(s):  
Katie J. Binger ◽  
Elayne D. Ansara ◽  
Talia M. Miles ◽  
Samantha L. Schulte
Keyword(s):  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Difference ◽  
Time To Relapse ◽  
Recovery Program

Abstract Introduction Opioid use disorder (OUD) can cause significant morbidity and mortality with more than 115 people dying from an opioid overdose daily in the United States. Treatment with buprenorphine/naloxone (BUP/NAL) can be effective; however, there is conflicting evidence on the utility of higher doses in preventing relapse. This study was designed to assess BUP/NAL maintenance doses and the rate of relapse in veterans with OUD. Methods Patients diagnosed with OUD who received a prescription for BUP/NAL through the substance use disorder recovery program were retrospectively evaluated. Patients were categorized into 2 treatment groups: those prescribed ≤16 mg of BUP/NAL daily and those prescribed &gt;16 mg of BUP/NAL daily. The primary outcome was to determine rates of relapse between maintenance doses of BUP/NAL. Secondary outcomes included evaluating the difference in rates of relapse between daily versus take-home dosing, tablets versus films, time to relapse, and use of illicit substances during treatment. Results Patients prescribed &gt;16 mg of BUP/NAL daily had statistically significantly lower rates of relapse compared to patients prescribed ≤16 mg of BUP/NAL daily (P = .0018). Regarding secondary outcomes, there was a statistically significant difference in time to relapse (P = .036) and dosage form (P = .0124). Difference in administration of dose and illicit substance use during treatment were not statistically significant. Discussion This study identified that rate of relapse can be lowered and time to relapse can be lengthened when doses &gt;16 mg of BUP/NAL are prescribed in the veteran population for OUD.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder

2021 ◽  
Vol 49 (3) ◽  
pp. 388-403
Author(s):  
William H. Gottdiener
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Psychodynamic Psychotherapy ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Self Medication ◽  
The Core ◽  
Wide Range ◽  
Opioid Use Disorders

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

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