Although counseling is a required part of office-based buprenorphine treatment of opioid use disorders, the nature of what constitutes appropriate counseling is unclear and controversial. The authors ...review the literature on the role, nature, and intensity of behavioral interventions in office-based buprenorphine treatment.
The authors conducted a review of randomized controlled studies testing the efficacy of adding a behavioral intervention to buprenorphine maintenance treatment.
Four key studies showed no benefit from adding a behavioral intervention to buprenorphine plus medical management, and four studies indicated some benefit for specific behavioral interventions, primarily contingency management. The authors examined the findings from the negative trials in the context of six questions: 1) Is buprenorphine that effective? 2) Is medical management that effective? 3) Are behavioral interventions that ineffective in this population? 4) How has research design affected the results of studies of buprenorphine plus behavioral treatment? 5) What do we know about subgroups of patients who do and those who do not seem to benefit from behavioral interventions? 6) What should clinicians aim for in terms of treatment outcome in buprenorphine maintenance?
High-quality medical management may suffice for some patients, but there are few data regarding the types of individuals for whom medical management is sufficient. Physicians should consider a stepped-care model in which patients may begin with relatively nonintensive treatment, with increased intensity for patients who struggle early in treatment. Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment.
Highlights • POATS (Prescription Opioid Addiction Treatment Study) was the largest clinical trial of prescription opioid dependence treatment. • Adding counseling to buprenorphine plus medical ...management did not improve outcome. • Long-term results showed higher abstinence rates compared to the main trial. • However, some patients initiated heroin use or heroin injection during follow-up.
Background
Despite the focus on overdose deaths co-involving opioids and benzodiazepines, little is known about the epidemiologic characteristics of benzodiazepine-involved overdose deaths in the ...USA.
Objective
To characterize co-involved substances, intentionality, and demographics of benzodiazepine-involved overdose deaths in the USA from 2000 to 2019.
Design
Cross-sectional study using national mortality records from the National Vital Statistics System.
Subjects
US residents in the 50 states and District of Columbia who died from a benzodiazepine-involved overdose from 2000 to 2019.
Main Measures
Demographic characteristics, intention of overdose, and co-involved substances
Key Results
A total of 118,208 benzodiazepine-involved overdose deaths occurred between 2000 and 2019 (median age, 43 IQR, 32–52; male, 58.6%; White, 93.3%; Black, 4.9%; American Indian and Alaska Native, 0.9%; Asian American and Pacific Islander, 0.9%; Hispanic origin, 6.4%). Opioids were co-involved in 83.5% of the deaths. Nine percent of benzodiazepine-involved overdose deaths did not involve opioids, cocaine, other psychostimulants, barbiturates, or alcohol. Overdose deaths were classified as suicides in 8.5% of cases with benzodiazepine and opioid co-involvement and 36.2% of cases with benzodiazepine but not opioid involvement. Rates of benzodiazepine-involved overdose deaths increased from 0.46 per 100,000 individuals in 2000 to 3.55 per 100,000 individuals in 2017 before decreasing to 2.96 per 100,000 individuals in 2019. Benzodiazepine-involved overdose mortality rates increased from 2000 to 2019 among all racial groups, both sexes, and individuals of Hispanic and non-Hispanic origin. Rates of benzodiazepine-involved overdose deaths decreased among White individuals, but not Black individuals, from 2017 to 2019.
Conclusions
Interventions to reduce benzodiazepine-involved overdose mortality should consider the demographics of, co-involved substances in, and presence of suicides among benzodiazepine-involved overdose deaths.
Abstract Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant ...increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a special issue of the Journal of Substance Abuse Treatment on prescription drug abuse provides an overview of the current status of the research literature in this area. The papers in this special issue include a sampling of the latest research on the epidemiology, clinical correlates, treatment, and public policy considerations of prescription drug abuse. Although much has been learned about prescription drug abuse in recent years, this research remains in early stages, particularly with respect to understanding effective treatments for this population. Future research priorities include studies on the interaction of prescription drugs with other licit and illicit substances, the impact of prescription drug abuse across the lifespan, the optimal treatment for prescription drug abuse and co-occurring conditions, and effective public policy initiatives for reducing prescription drug abuse.
This paper describes the initial meetings of the American Academy of Addiction Psychiatry, and it compares and contrasts these relatively small meetings with the much larger meetings today. The paper ...is centered on the organization's initial focus on establishing itself in the mainstream of medicine and psychiatry. (Am J Addict 2020;00:00–00)
Highlights • This is the first study of risks for substance use/substance use disorder (SUD) treatment in transgender men and women. • We assessed psychosocial risk factors for substance use and SUD ...treatment in transgender adults. • Substance use and SUD treatment are linked to age, education, poverty and male-to-female identity. • Substance use and SUD treatment are linked to violence/PTSD, discrimination, housing and sex work. • SUD treatment should incorporate psychosocial/structural approaches for transgender adults.
Background
Sustained abstinence is currently the only accepted end‐point for pharmacotherapy trials for most substance use disorders (SUD), with the exception of alcohol. Despite recent efforts, the ...identification of a non‐abstinence alternative as a clinically meaningful end‐point for drug use trials has been elusive.
Argument and analysis
The current standard for establishing a clinically meaningful outcome in SUD trials is to demonstrate that a reduction in drug use is associated with improvement in long‐term functioning, but data indicate relatively weak associations between drug use and various psychosocial problem domains. This may be because assessments used most commonly to measure an individual's functioning do not specify whether aspects of functioning are a direct consequence of drug use. The acceptance of a non‐abstinence‐based end‐point for alcohol use disorder trials was supported in part through associations with reductions in alcohol‐related consequences, although measures designed to assess the direct consequences of drug use are rarely included in drug treatment efficacy trials.
Conclusions
The field of substance use disorders should include measures of negative psychosocial and health consequences of drug use, as opposed to overall functioning, in the effort to establish meaningful non‐abstinence‐based end‐points.
Alcohol use disorders in pregnancy DeVido, Jeffrey; Bogunovic, Olivera; Weiss, Roger D
Harvard review of psychiatry,
03/2015, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Alcohol use disorders (AUDs) are less prevalent in pregnant women than in nonpregnant women, but these disorders can create a host of clinical challenges when encountered. Unfortunately, little ...evidence is available to guide clinical decision making in this population. Drinking alcohol during pregnancy can have negative consequences on both fetus and mother, but it remains controversial as to the volume of alcohol consumption that correlates with these consequences. Likewise, little evidence is available to support the use of particular pharmacologic interventions for AUDs during pregnancy or to guide the management of alcohol detoxification in pregnant women. The use of benzodiazepines (the mainstay of most alcohol detoxification protocols) in pregnant women is controversial. Nevertheless, despite the lack of robust data to guide management of AUDs in pregnancy, clinicians need to make management decisions when confronted with these challenging situations. In that context, this article reviews the epidemiology of AUDs in pregnancy and the pharmacologic management of both AUDs and alcohol withdrawal in pregnant women, with the goal of informing clinicians about what is known about managing these co-occurring conditions.
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