Substance abuse disorders treatment

American Academy of Child and Adolescent Psychiatry Practice parameters for the assessment and treatment of children and adolescents with substance abuse disorders. J Am Acad Child Adolesc Psychiatry 37 122—126, 1998 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000... 

Bipolar patients with substance abuse disorders are more likely to have an earlier onset of illness, mixed states, higher relapse rates, poorer response to treatment, higher suicide risk, and more hospitalizations. 

One unpredictable benefit of MPH treatment, according to a 1999 research paper, is that children with ADHD who receive MPH treatment may be less likely to develop substance abuse disorders. 

These symptoms usually are not directly treated with psychotropic medications. Rather the primary medical disorder is treated, or the patient is referred for treatment of a chemical dependency problem (see chapter 12). When psychotropics are employed, they generally are used for short periods of time. Medications of choice are the benzodiazepines (although they should be used with extreme caution in patients with a substance abuse disorder). 

The book explores and explains the development of addiction, the various classes of drugs, and the treatment and prevention of substance abuse disorders. With the latest research and data, the authors include ... 

It is important to screen patients for co-occurring mental disorders, and their presence may become more apparent during the stabilization or maintenance phases of schizophrenia treatment. Examples include substance abuse disorders, depression, obsessive-compulsive disorder, and panic disorder. As co-occurring disorders will limit symptom and functional improvement and increase the risk of relapse, it is critical that they be appropriately treated. Pharmacological and nonpharmacological interventions specific for the co-occurring disorder should be implemented in combination with evidence-based treatment for schizophrenia. 

Future Outlook for Pharmacologic Treatment of Abuse and Dependence. The importance of the psychosocial dimension ia predisposiag iadividuals toward substance use disorders and subsequentiy maintaining the disorder caimot be overestimated. Additionally, genetic influences have been found to exert an important influence on HabiUty for dmg abuse. A high comorbidity of psychiatric illnesses with substance use disorders further compHcates therapeutic iaterventions ia such patients (236). 

Sullivan LE, O Connor PC Medical disorders in substance abuse patients, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 515-553... 

McLellan AT Psychiatric severity as a predictor of outcome from substance abuse treatments, in Psychopathology and Addictive Disorders. Edited by Meyer RE. New York, Guilford, 1986, pp 97-139... 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

Much less attention has been paid to chronic PCP use per se, i.e., the substance use disorder itself. Such issues as the effects of chronic PCP use, and the diagnosis, clinical characterization, and treatment of chronic PCP abusers are rarely discussed in the published literature, even in detailed review articles (Davis 1982 Pearlson 1981 Pradhan 1984). This paper reviews the literature on inpatient and outpatient treatment of PCP abuse, outlines our own experience with PCP users and abusers in one large, public, urban hospital, and makes suggestions for future research based on this information and animal research findings (Balster, this volume). 

A number of medications have been studied to alleviate symptoms of stimulant withdrawal and the intense craving that may accompany it, but inconsistent results across controlled trials preclude any recommendations for their routine use. Patients with stimulant use disorders should be referred to substance abuse treatment because of the high risk for continued use either during or immediately following stimulant withdrawal. 

Lifetime prevalence rates of psychiatric comorbidity co-existing with bipolar disorder are 42% to 50%.16 Comorbidities, especially substance abuse, make it difficult to establish a definitive diagnosis and complicate treatment. Comorbidities also place the patient at risk for a poorer outcome, high rates of suicidal-ity, and onset of depression.2 Psychiatric comorbidities include ... 

Divalproex sodium is comprised of sodium valproate and valproic acid. The delayed-release and extended-release formulations are converted in the small intestine into valproic add, which is the systemically absorbed form. It was developed as an antiepileptic drug, but also has efficacy for mood stabilization and migraine headaches. It is FDA-approved for the treatment of the manic phase of bipolar disorder. It is generally equal in efficacy to lithium and some other drugs for bipolar mania. It has particular utility in bipolar disorder patients with rapid cycling, mixed mood features, and substance abuse comorbidity. Although not FDA-approved for relapse prevention, studies support this use, and it is widely prescribed for maintenance therapy. Divalproex can be used as monotherapy or in combination with lithium or an antipsychotic drug.31... 

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