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4 results

  • Chapter 3 - Illicit Drug Use: Clinical Features and Treatment

  • Edited by Ed Day
  • Book:
    Seminars in Addiction Psychiatry
    Published online:
    02 November 2021
    Print publication:
    04 November 2021, pp 42-67

  • Summary

    This chapter starts by describing the key features of drug use disorders and how to assess them, including using objective tests of substance use. The principles of medical treatment are described, incorporating harm reduction strategies, medically assisted withdrawal, agonist therapies and relapse prevention. Opiates are used as a case study to consider the theory and practicalities of each approach, before describing how to integrate psychosocial interventions into an integrated approach to treatment. Stimulants and cannabis are then considered, before a review of the overarching concept of recovery and its application in recovery-orientated systems of care.

  • Trauma and post-traumatic stress disorder in patients treated for opioid use disorder: findings from a 12-month cohort study

  • Tea Rosic, Vivian Y. O. Au, Andrew Worster, David C. Marsh, Lehana Thabane, Zainab Samaan
  • Journal:
    BJPsych Open / Volume 7 / Issue 4 / July 2021
    Published online by Cambridge University Press:
    22 July 2021, e138
    • Article
      • You have access
      • Open access
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  • Background

    Exposure to traumatic events is both a risk factor for substance use and an adverse outcome of substance use disorders. Identifying and managing post-traumatic stress disorder (PTSD) in patients with addiction requires attention.

    Aims

    To examine the lifetime prevalence of traumatic events and past-month prevalence of PSTD in patients treated for opioid use disorder, and explore the association between trauma, PTSD and treatment outcomes.

    Method

    Participants (n = 674) receiving methadone treatment in 20 community clinics across Ontario, Canada, were administered the Mini-International Neuropsychiatric Interview to identify self-reported traumatic events and PTSD. Drug use was measured for 12 months by urine drug screens.

    Results

    Eleven per cent of participants met past-month criteria for PTSD (n = 72), and 48% reported history of traumatic events with no current PTSD (n = 323). Participants with PTSD were more likely to be female (odds ratio 2.13, 95% CI 1.20–3.76) and less likely to be employed (odds ratio 0.31, 95% CI 0.16–0.61) or married (odds ratio 0.51, 95% CI 0.26–0.90) than those with no trauma history. Antidepressants (39 v. 24%) and benzodiazepines (36 v. 18%) were differentially prescribed to patients with and without PTSD. Length of time in treatment and opioid use were not associated with trauma; however, suicidal ideation was more common in PTSD (odds ratio 2.29, 95% CI 1.04–5.01).

    Conclusions

    Trauma and PTSD are prevalent among patients with opioid use disorder, and consideration of trauma symptoms and associated characteristics is warranted. Patients with and without comorbid PTSD differ clinically and psychosocially, highlighting the relevance of integrating addiction and mental health services for this population.

  • Chapter 28 - Children’s reactions and consequences of illness and hospitalization and transition of care from pediatric to adult settings

  • Edited by James J. Amos, University of Iowa, Robert G. Robinson, University of Iowa
  • Book:
    Psychosomatic Medicine
    Published online:
    04 August 2010
    Print publication:
    27 May 2010, pp 249-258

  • Summary

    Evaluation of suspected alcohol withdrawal should start by obtaining a complete alcohol use history. Symptom-triggered treatment of alcohol withdrawal using assessment scales such as the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is the preferred method. A score of less than ten indicates the need for continued monitoring of the patient. A score of 10 to 15 indicates mild withdrawal, 16 to 20 moderate withdrawal, and greater than 20 severe withdrawal. Sedative/hypnotic (benzodiazepine, barbiturate, and related drug) withdrawal is managed by the same principles used to treat alcohol withdrawal. The consultant may be called upon to assist in managing opioid withdrawal related to illicit use, problems with prescription analgesics, or ongoing opioid agonist therapy (OAT) for addiction. Federally accredited opioid treatment programs (OTPs) can administer methadone or buprenorphine for detoxification or maintenance as part of a comprehensive treatment program.