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substance abuse

Genetics: allelic associations Epidemiology: - 10% of adults in U.S. have had a drug use disorder [18] - teen substance abuse down, marijuana use stable [19] - ADHD medications diverted by parents [20] - increase in opioid use disorder & fatal overdoses among Medicare recipients since 2013 [27,28] History: - ask "How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?" [8] Clinical manifestations: - periods of relapse & remission - failure to complete responsibilities or obligations - an unsuccessful desire to cut down - elderly may not need escalting doses to achieve same effect Complications: - addiction - hepatitis C & endocarditis with IV drug abuse [17] Management: 1) coupling of substance abuse treatment with primary medical care 2) collaborative care model in primary care doubles likelihood patient will receive evidence-based treatment [21] 3) a chronic care management program is no better than usual care in promoting abstinence in patients with alcohol or drug dependence [5] 4) brief interventions given in the primary care setting do not help reduce problem drug use [16] 5) relapse prevention - naltrexone implant 1000 mg (8-10 weeks duration) [3] 6) screening - single question "How often have you used...?" with high sensitivity (75-100%) & specificity (84-98%) among teens [15] - U.S. Preventive Services Task Force recommends that primary care clinicians screen adults, including pregnant & postpartum women, for unhealthy drug use [26] 7) mobile application (Reset app) FDA-approved [22] - patient application & a clinician dashboard - delivers cognitive behavioral therapy - no benefit for patients with primary opioid abuse 8) computerized cognitive-behavioral therapy (CBT) outperforms standard (office-based) CBT - effects are longer-lasting than clinician-delivered CBT, for a wide array of substance use disorders [23]

Related

addiction (psychological dependence)

Specific

alcohol abuse (includes alcohol use disorder, risky alcohol use) alcoholism (includes binge drinking) bath salt abuse (Cloud 9, Blizzard, Ivory Snow, Ivory Wave, Purple Wave, Vanilla Sky, Red Dove, Blue Silk) cocaine abuse diuretic abuse intravenous drug abuse (IVDA, injection drug use, IDU) laxative abuse opiate abuse; opioid use disorder pink cocaine; tusi poppers prescription drug abuse smoking; cigarette smoking; tobacco smoking tobaccoism

General

drug adverse effect(s) of mental disorder

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16. American College of Physicians, Philadelphia 1998, 2009, 2012
  2. Treatment Improvement Protocol (SAMHSA) Substance Abuse Treatment for Persons with Co-occurring Disorders http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.74073
  3. Tiihonen J et al. Naltrexone implant for the treatment of polydrug dependence: A randomized controlled trial. Am J Psychiatry 2012 Feb 17 PMID: 22362396 http://psychiatryonline.org/article.aspx?articleid=668179&journalid=13
  4. Belani H et al Centers for Disease Control and Infection Integrated Prevention Services for HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis for Persons Who Use Drugs Illicitly: Summary Guidance from CDC and the U.S. Department of Health and Human Services MMWR. Nov 9, 2012 / 61(rr05);1-40 PMID: 23135062 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6105a1.htm
  5. Saitz R et al Chronic Care Management for Dependence on Alcohol and Other Drugs. The AHEAD Randomized Trial. JAMA. 2013;310(11):1156-1167 PMID: 24045740 http://jama.jamanetwork.com/article.aspx?articleid=1738895 - O'Connor PG. Managing substance dependence as a chronic disease: Is the glass half full or half empty? JAMA 2013 Sep 18; 310:1132 PMID: 24045739
  6. Prescriber's Letter 20(12): 2013 Drugs of Abuse Detail-Document#: 291211 (subscription needed) http://www.prescribersletter.com
  7. Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010 Sep;4(3):123-30 PMID: 20936079
  8. Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A single-question screening test for drug use in primary care. Arch Intern Med. 2010 Jul 12;170(13):1155-60 PMID: 20625025
  9. Kleber HD, Weiss RD, Anton RF Jr et al Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry. 2007 Apr;164(4 Suppl):5-123. PMID: 17569411
  10. Blazer DG, Wu LT. The epidemiology of substance use and disorders among middle aged and elderly community adults: national survey on drug use and health. Am J Geriatr Psychiatry. 2009 Mar;17(3):237-45 PMID: 19454850
  11. Oslin DW. Evidence-based treatment of geriatric substance abuse. Psychiatr Clin North Am. 2005 Dec;28(4):897-911, PMID: 16325734
  12. Rosen D, Hunsaker A, Albert SM, Cornelius JR, Reynolds CF 3rd. Characteristics and consequences of heroin use among older adults in the United States: a review of the literature, treatment implications, and recommendations for further research. Addict Behav. 2011 Apr;36(4):279-85. PMID: 21237575
  13. Lin JC, Karno MP, Grella CE, Warda U, Liao DH, Hu P, Moore AA. Alcohol, tobacco, and nonmedical drug use disorders in U.S. Adults aged 65 years and older: data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions. Am J Geriatr Psychiatry. 2011 Mar;19(3):292-9. PMID: 20808122
  14. Moore AA, Karno MP, Grella CE et al Alcohol, tobacco, and nonmedical drug use in older U.S. Adults: data from the 2001/02 national epidemiologic survey of alcohol and related conditions. J Am Geriatr Soc. 2009 Dec;57(12):2275-81. PMID: 19874409
  15. Levy S et al An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels. JAMA Pediatr. Published online July 28, 2014 PMID: 25070067 http://archpedi.jamanetwork.com/article.aspx?articleid=1889047 - Subramaniam GA and Volkov ND Substance Misuse Among AdolescentsTo Screen or Not to Screen? JAMA Pediatr. Published online July 28, 2014 PMID: 25069987 http://archpedi.jamanetwork.com/article.aspx?articleid=1889046
  16. Roy-Byrne P et al Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings. A Randomized Clinical Trial. JAMA. 2014;312(5):492-501 PMID: 25096689 http://jama.jamanetwork.com/article.aspx?articleid=1892249 - Saitz R, et al Screening and Brief Intervention for Drug Use in Primary Care. The ASPIRE Randomized Clinical Trial. JAMA. 2014;312(5):502-513 PMID: 25096690 http://jama.jamanetwork.com/article.aspx?articleid=1892250 - Hingson R and Compton WM Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary CareBack to the Drawing Board. JAMA. 2014;312(5):488-489 PMID: 25096687 http://jama.jamanetwork.com/article.aspx?articleid=1892226
  17. Wakeman SE et al Case 35-2014 - A 31-Year-Old Woman with Fevers, Chest Pain, and a History of HCV Infection and Substance-Use Disorder. N Engl J Med 2014; 371:1918-1926. November 13, 2014 PMID: 25390743 http://www.nejm.org/doi/full/10.1056/NEJMcpc1407131
  18. Grant BF et al Epidemiology of DSM-5 Drug Use Disorder. Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry. Published online November 18, 2015. PMID: 26580136 http://archpsyc.jamanetwork.com/article.aspx?articleid=2470680
  19. NIH News Release. Dec 13, 2016 Teen substance use shows promising decline. NIH Monitoring the Future survey shows use of most illicit substances down, but past year marijuana use relatively stable. https://www.nih.gov/news-events/news-releases/teen-substance-use-shows-promising-decline
  20. Pham T, Milanaik R, Kaplan A, Papaioannou H, Adesman A. Household diversion of prescription stimulants: Medication misuse by parents of children with attention-deficit/ hyperactivity disorder. J Child Adolesc Psychopharmacol 2017 Jul 7 PMID: 28686059
  21. Watkins KE, Ober AJ, Lamp K et al Collaborative Care for Opioid and Alcohol Use Disorders in Primary CareThe SUMMIT Randomized Clinical Trial JAMA Intern Med. Published online August 28, 2017. PMID: 28846769 http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2652574
  22. FDA News Release. September 14, 2017 FDA permits marketing of mobile medical application for substance use disorder. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm576087.htm
  23. Kiluk BD, Nich C, Buck MB et al. Randomized clinical trial of computerized and clinician-delivered CBT in comparison with standard outpatient treatment for substance use disorders: Primary within-treatment and follow-up outcomes. Am J Psychiatry 2018 May 24; PMID: 29792052 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.17090978
  24. Nackers KA et al. Substance abuse, general principles. Pediatr Rev 2015 Dec; 36:535 PMID: 26628734
  25. Lehmann SW, Fingerhood M. Substance-Use Disorders in Later Life. N Engl J Med 2018; 379:2351-2360. PMID: 30575463 https://www.nejm.org/doi/full/10.1056/NEJMra1805981
  26. US Preventive Services Task Force Screening for Unhealthy Drug Use US Preventive Services Task Force Recommendation Statement, JAMA. 2020;323(22):2301-2309. PMID: 32515821 https://jamanetwork.com/journals/jama/fullarticle/2766873 - Patnode CD, Perdue LA, Rushkin M et al Screening for Unhealthy Drug UseUpdated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020;323(22):2310-2328 PMID: 32515820 https://jamanetwork.com/journals/jama/fullarticle/2766872 - Saitz R Screening for Unhealthy Drug UseNeither an Unreasonable Idea Nor an Evidence-Based Practice. JAMA. 2020;323(22):2263-2265. PMID: 32515804 https://jamanetwork.com/journals/jama/fullarticle/2766846
  27. Shoff C, Yang TC, Shaw BA. Trends in Opioid Use Disorder Among Older Adults: Analyzing Medicare Data, 2013-2018. Am J Prev Med. 2021 Jun;60(6):850-855 PMID: 33812694 PMCID: PMC8154702 Free PMC article.
  28. Humphreys K, Shover CL Twenty-Year Trends in Drug Overdose Fatalities Among Older Adults in the US. JAMA Psychiatry. 2023;80(5):518-520 PMID: 36988923 PMCID: PMC10061315 (available on 2024-03-29) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2802945
  29. Kuerbis A, Sacco P, Blazer DG, Moore AA. Substance abuse among older adults. Clin Geriatr Med. 2014 Aug;30(3):629-54. PMID: 25037298 Free PMC article. Review.
  30. National Institute of Drug Abuse The Science of Drug Abuse and Addiction: The Basics. http://www.drugabuse.gov/publications/media-guide/science-drug-abuse-addiction-basics
  31. NIDA Drug Screening Tool NIDA-Modified ASSIST (NM ASSIST) https://www.drugabuse.gov/nmassist/