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Archive for the 'Pharmacotherapy' Category


Substance Abuse and Mental Disorders

Posted by Lakeside on 9th June 2008

Man with co-occurring substance abuse and mental disorder The Co-Occurring Center for Excellence. Addressing mental disorders and alcoholism, addiction co-occurring.

The Co-Occurring Center for Excellence (COCE) was created by SAMHSA in 2003 to provide information and a range of services to mental health and substance abuse administrators and policymakers at state and local levels, their counterparts in tribal and Native populations, clinical providers, other providers, and all other agencies and systems through which clients may enter the treatment system.

COCE provides state-of-the-art and sustainable technical assistance, training, information and resources, and links to other resources that serve persons with co-occurring disorders.

http://www.coce.samhsa.gov/

See also;

          The Dual Diagnosis Recovery Sourcebook :
A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder

by Dennis Ortman

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Posted in Alcohol, Alcoholism, Contrast to other models, Drugs, Medication, Pharmacotherapy, Recovery, Relapse prevention, Symptoms of addiction, Target populations, Training | No Comments »

Antidepressant Induced Mania

Posted by Lakeside on 6th June 2008

angry manic man Antidepressant Induced Mania (ADM) Among People with Co-Occurring Disorders (COD). Sometimes, informally called Bipolar III disorder.

A recent study of medical charts at a bipolar specialty clinic gives new support to the idea that antidepressants can induce mania in some bipolar patients.

For some time, clinicians have been concerned about the problem of antidepressant-induced mania (ADM), but most research has not supported the connection between antidepressants and manic or hypomanic episodes.

This study looked at ADM and examined differences between patients with bipolar disorder and a substance use disorder (SUD) and patients without SUD.

The article presents solid evidence for a significantly increased risk of ADM in patients with co-occurring bipolar disorder and SUD. The article also comments about why the increased risk to these clients may not have been identified in prior research.

Manwani and colleagues investigated medical charts from 98 patients who were treated at a bipolar clinic between 2000 and 2004. These patients accounted for 335 antidepressant trials during that period. Of the sample, 55 patients (accounting for 184 of the trials) had a lifetime history of a SUD.

For this study, an episode of ADM was defined as hypomanic or manic symptoms within 12 weeks of beginning a new antidepressant medication.

There were some substantial differences between patients who did and did not have a SUD history—e.g., clients with SUD were almost twice as likely as those without SUD to be prescribed lithium (48.3% vs. 28.5%), and clients without SUD were twice as likely to receive divalproex as those with SUD (43% vs. 20.1%) and almost three times as likely to be prescribed an antipsychotic (31.8% vs. 11.4%).

The univariate analysis of differences in the number of antidepressant trials leading to ADM between patients with and without a SUD history showed little difference in the percentage of ADM episodes they experienced (20.7% of trials for those with SUD and 21.4% of trials for those without).

However, using a multivariate regression model of analysis, the authors found that:

  • Patients with a lifetime SUD were five times as likely to experience ADM,
  • The incidence of an antidepressant trial leading to an ADM was greater for clients with Type II or with bipolar disorder not otherwise specified than for Type I,
  • Females were more likely than males to have an episode of ADM in response to an antidepressant trial, and
  • Bupropion was the antidepressant least likely to cause an ADM.

The authors surmise that older research studies excluding people with a SUD might have led to subject pools that underrepresented individuals considerably more likely to experience an ADM than the subjects studied. Additionally, they describe how other confounding factors might have served to hide the effects of having a history of SUD on the likelihood of suffering an ADM.

A discussion of the limitations of their study (e.g., it was non-randomized, non-blind; concomitant therapy may have obscured treatment effect; no measures of adherence to medication regimens) is also given.

Research; Manwani, S. G., Pardo, T. B., Albanese, M. J., Zablotsky, B., Goodwin, F. K., & Ghaemi, S. N. (2006). Substance use disorder and other predictors of antidepressant-induced mania: a retrospective chart review. Journal of Clinical Psychiatry, 67(9), 1341–1345.

Co-Occurring Disorders Research and Resources Monthly Review. The Co-Occurring Center for Excellence (COCE), of the Substance Abuse and Mental Health Services Administration (SAMHSA), Vol. 1, No. 5, December 2006. Readers interested in finding out more about COCE should visit the Web site: http://coce.samhsa.gov/

See also;

          Dual Diagnosis,
Counseling the Mentally Ill Substance Abuser

by Katie Evans, J. Michael Sullivan

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Posted in Adjunctive therapy, Alcohol, Alcoholism, Assessment, Drugs, Medication, Pharmacotherapy, Recovery, Relapse prevention, Research, Target populations | No Comments »

25 Top Posts at BriefTSF

Posted by Lakeside on 1st June 2008

Popular Blogging at BriefTSF

          Understanding and Counselling the Alcoholic
by Jr. Howard J. Clinebell

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Posted in Addiction, Adult Children of Alcoholics, Alcohol, Alcoholics Anonymous, Alcoholism, Blogroll, Brief-TSF, Drugs, Higher Power, Inhalants, Medication, PTSD, Pharmacotherapy, Recovery, Relapse prevention, Research, Spirituality, Stages of Change, Symptoms of addiction, TSF, Target populations, Training, Women | No Comments »

Acamprosate for Alcohol Craving

Posted by Lakeside on 30th May 2008

Alcoholic Beverage Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials.

In 2004, the United States Food and Drug Administration (FDA) approved acamprosate for use in conjunction with psychosocial support in the maintenance of abstinence in alcohol-dependent patients who are abstinent at treatment initiation.

That approval was based primarily on a re-analysis of three European double-blind, placebo-controlled trials in which complete abstinence was the primary outcome measure.

The current report presents data from the re-analysis of the pivotal trials, which were 13-, 48-, and 52-week studies. A total of 998 DSM-III-R alcohol-dependent patients were included in the studies, with the majority abstinent at randomization. Using a more stringent definition of abstinence, re-analysis of the rate of complete abstinence, percent days abstinent, and the time to first drink confirmed the original findings for the efficacy of acamprosate in the treatment of alcohol dependence.

Rate of complete abstinence was significantly higher with acamprosate than placebo (p < .05); both percent days abstinent and time to first drink were also significantly greater among acamprosate-treated than placebo-treated patients (p < .01).

These findings support the use of acamprosate in the treatment of alcohol dependence and illustrate some of the issues that can arise in the FDA process for approval of medications to treat the disorder.

Am J Addict. 2008 Jan-Feb;17(1):70-6. Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials. Kranzler HR, Gage A.

See also;

          Handbook of Alcoholism Treatment Approaches (3rd Edition)
by Reid K. Hester, William R. Miller

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Posted in Adjunctive therapy, Alcohol, Alcoholism, Medication, Pharmacotherapy, Relapse prevention, Research, Training | No Comments »

Natrexone for Alcoholics

Posted by Lakeside on 6th May 2008

 

A synopsis of the pharmacological rationale, properties and therapeutic effects of depot preparations of naltrexone for treating alcohol dependence.

Although oral naltrexone has been shown to diminish alcohol reinforcement, its limitations as a medication include its small treatment effect size, plasma level fluctuation and adverse events.

The pharmacokinetic profile of naltrexone could be optimised by intramuscular administration, sustaining its release over several weeks.

As a result, plasma levels would remain relatively constant; high enough to reduce drinking, low enough to minimise side effects.

Two injectable naltrexone depot preparations, Vivitrex and Naltrel, have been tested as pharmacotherapy for alcohol dependence.

Their adverse-event profiles seem to be mild compared with oral naltrexone.

Vivitrex has shown efficacy at reducing heavy drinking significantly among alcohol-dependent men.

Naltrel helped reduce relapse and promote abstinence in two samples of alcohol-dependent individuals. Additional efficacy studies are warranted.

Johnson BA. Expert Opin Pharmacother. 2006 Jun;7(8):1065-73. A synopsis of the pharmacological rationale, properties and therapeutic effects of depot preparations of naltrexone for treating alcohol dependence.
          Pharmacotherapy Principles & Practice
by Marie A. Chisholm-Burns, Barbara G. Wells, Terry L. Schwinghammer, Patrick M. Malone, Jill M. Kolesar, John C. Rotschafer, Joseph T. DiPiro

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Popular Articles

Posted by Lakeside on 15th April 2008

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Posted in 12-Step Groups, Addiction, Adult Children of Alcoholics, Al-anon, Alcohol, Alcoholics Anonymous, Alcoholism, Assessment, Brief-TSF, Co-dependency, Disease of addiction, Drugs, Family, Gambling, Higher Power, Medication, Men, Mutual-help, Pharmacotherapy, Recovery, Relapse prevention, Self-help, Spirituality, Symptoms of addiction, TSF, Women, Youth | No Comments »

Naltrexone Cuts Alcoholics Drinking

Posted by Lakeside on 7th April 2008

Alcohol 99 Early treatment response in alcohol dependence with extended-release naltrexone.

OBJECTIVE: We sought to determine the time course for onset of effect of intramuscular injectable extended-release naltrexone (XR-NTX), which has demonstrated efficacy for alcohol dependence.

METHOD: A post hoc analysis of a randomized, double-blind, placebo-controlled, multicenter study was conducted. In the study, actively drinking men and women who met DSM-IV-TR criteria for alcohol dependence were randomly assigned to receive injections of XR-NTX 380 mg (N = 205) or 190 mg (N = 210) or placebo (N = 209) every 4 weeks for 24 weeks. Patients also received 12 sessions of adjunctive standardized, low-intensity psychosocial intervention. Drinking data were analyzed by month and, during the first month, by day to explore the time course for onset of effect on heavy drinking days in patients receiving XR-NTX versus placebo. The study data were collected between February 2002 and September 2003.

RESULTS: During the first month following injection, patients receiving XR-NTX 380 mg had 37% fewer heavy drinking days versus placebo (p < .01). By day 2, a significant reduction in the median number of drinks consumed per day was observed in patients given XR-NTX 380 mg compared with placebo (p < .05). By day 3, XR-NTX 380 mg resulted in a significant reduction in the percentage of patients reporting heavy drinking compared with placebo (p < .05); this reduction was maintained throughout the study. A dose-response effect was observed, with intermediate results for XR-NTX 190 mg.

CONCLUSION: XR-NTX 380 mg provided a rapid onset of therapeutic effect in the first 2 days after the first injection that was sustained throughout the 24-week trial. Potential clinical implications of the rapid, early onset of effect of this medication’s delivery system for patients who are dependent on alcohol include facilitation of early engagement in treatment, motivation to continue treatment, and focus on the goals established in counseling.

Research; J Clin Psychiatry. 2008 Feb;69(2):190-5. Early treatment response in alcohol dependence with extended-release naltrexone. Ciraulo DA, Dong Q, Silverman BL, Gastfriend DR, Pettinati HM.

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Anti Craving Medication Works

Posted by Lakeside on 14th March 2008

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Extended-Release Naltrexone Works Particularly Well for Abstinent Patients with Dependence

Many patients with alcohol dependence do not receive the full benefits of treatment because they do not adhere to it. In part to address issues with adherence, extended-release (ER) naltrexone, which is released over a month after one injection, was developed. Pharmacotherapy researchers assessed ER-naltrexone efficacy in a subgroup of 82 subjects in a larger clinical trial who had ?4 days of abstinence.

In that subgroup, 380 mg of ER-naltrexone in 28 subjects versus placebo in 28 subjects

  • increased the time to first drink (median days, 41 versus 12);
  • increased continuous abstinence over 6 months (32% versus 11%);
  • increased time to first heavy drinking (>180 versus 20 days);
  • decreased days with any drinking (median days per month, 0.7 versus 7.2);
  • decreased days with heavy drinking (median days per month, 0.2 versus 2.9).

Smaller benefits, which were not always statistically significant, were found among 28 subjects treated with 190 mg of ER-naltrexone.

Comments by Michael Levy, PhD:
In this industry-sponsored secondary analysis of a small subgroup of subjects who had achieved just 4 or more days of abstinence before entering treatment, those who received ER-naltrexone in conjunction with psychosocial treatment had better treatment outcomes than those who received placebo. Medications with proven benefit for the treatment of alcohol dependence tend to be underutilized in general. This study suggests that ER-naltrexone is another treatment option for clients with alcohol dependence who have achieved even a short duration of abstinence.

Research Reference: O’Malley SS, Garbutt JC, Gastfriend DR, et al. Efficacy of extended-release naltrexone in alcohol-dependent patients who are abstinent before treatment. J Clin Psychopharm. 2007;27(5):507–512.

From; Join Together Online

Brief-TSF is designed to as adjunctive therapy for anti-craving medication.


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Posted in Adjunctive therapy, Alcohol, Alcoholism, Medication, Pharmacotherapy, Research, Stages of Change, Symptoms of addiction | No Comments »

Prescription Drug Overdose Becomes Big Killer

Posted by Lakeside on 12th February 2008

 

pills Washington residents are dying from unintended drug poisoning in numbers beginning to approach deaths in car crashes, and overdose deaths blamed on legal drugs now exceed fatal overdoses caused by illicit drugs, the Spokane Spokesman-Review reported Feb. 4th 2008.

Prescription-drug overdoses have increased 800 percent in Washington between 1995, when 45 overdose deaths were reported, to 2004, when 411 state residents died from overdoses on drugs like hydrocodone and methadone. “Prescription drug overdose deaths have been climbing through the roof,” said Jennifer Sabel, an epidemiologist at the Washington Department of Health. “Even doctors don’t really realize the magnitude of the deaths.”

In nearby Idaho, drug poisonings rose from 32 in 2000 to 62 in 2004. Some victims died because they misused patches containing powerful painkillers like Fentanyl, while others suffered from a toxic mix of prescription painkillers and alcohol or over-the-counter medications like Benadryl. “Users may be lulled into thinking prescription medications are safe as opposed to ’street drugs,’ ” said Spokane County Medical Examiner Sally Aiken.

Overall opiate-related deaths in Washington rose from 260 in 1995 to 555 in 2004; auto crashes kill about 650 residents in the state each year. Mentions of prescription opiates on death certificates has risen even as involvement of illicit drugs like heroin have fallen by a third during the same period.

The trend is echoed by research conducted by the federal Centers for Disease Control and Prevention (CDC), which found that mentions of narcotic painkillers on death certificates rose 91 percent between 1999 and 2002. “This is a national problem,” said Dr. Gary Franklin, medical director for Washington’s Department of Labor and Industries.

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50 Most Read Articles January 2008

Posted by Lakeside on 7th February 2008

laptop 5

  1. 12-Step Recovery Theory and Application
  2. AA and the disease concept of alcoholism
  3. AA attendance was best predictor of abstinence
  4. AA Membership
  5. AA Recommendations
  6. Abstinent alcoholics can have reduced brain activation
  7. Al-Anon offers new life
  8. Alcohol Abuse in Older People
  9. Alcohol consumption in patients pancreatitis
  10. Alcohol Metabolization
  11. Alcoholic jealousy
  12. Alcoholics & Addicts Can’t ‘Just Say No’
  13. Alcoholics Anonymous and church involvement
  14. Alcoholics can benefit from Al-Anon
  15. Alcoholics don’t see dangerous situation
  16. Alcoholism and Personality Disorders
  17. Alcoholism is also Genetic
  18. ALCOHOLISM MYTHS
  19. Anti-craving Naltrexone Injection Reduces Drinking
  20. Beyond Codependency
  21. Brief-TSF Description
  22. Brief-TSF holistic treatment
  23. COUNSELOR CHARACTERISTICS
  24. Craving Reduction
  25. Effects of gambling addiction
  26. Elderly substance abuse
  27. Free Inhalant Abuse Education
  28. Management of substance-abuse disorders
  29. Mindfulness Can Help Recovery
  30. Neurotransmitter and neuromodulatory mechanisms involved in alcohol abuse and alcoholism
  31. Physician Screening for Alcohol Cost Effective but Underutilized
  32. Relapse Prevention in Primary Care
  33. Return to Drinking After Liver Transplantation for Alcoholic Liver Disease
  34. Screening Can Decrease Teen Risk Behaviors
  35. Spiritual Awakening for Recovery
  36. Spirituality and Helping in Alcoholics Anonymous
  37. Strategies for Dealing With Denial
  38. Symptoms of alcoholism
  39. The Aging Alcoholic
  40. THE DRY DRUNK
  41. Therapeutic Alliance
  42. Treatment and twelve-step strategies
  43. TSF Description
  44. Twelve Step recovery is spiritual
  45. TWELVE STEPS TO RECOVERY FROM BURNOUT
  46. UK Alcohol and Drug Professional Training
  47. What about partners of alcoholics?
  48. What About This Spiritual Awakening Thing
  49. What is Brief-TSF?

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