ries non severe

7/25/2019 Ries Non Severe

1/98

Co-occurring Addiction andCo-occurring Addiction andLess SevereLess Severe

Mental DisordersMental Disorders

Richard Ries MDRichard Ries MD

[email protected]@u.washington.eduHarborview Medical CenterHarborview Medical Center

University of WashingtonUniversity of Washington

eattle! Waeattle! Wa
mailto:[email protected]:[email protected]:[email protected]


2/98

DUAL DIAGNOSIS IS:DUAL DIAGNOSIS IS:

TWO DIAGNOSES/ DISORDERSTWO DIAGNOSES/ DISORDERS

TWO SYSTEMSTWO SYSTEMS

DOUBLE TROUBLEDOUBLE TROUBLE

IN THE EYE OF THE BEHOLDERIN THE EYE OF THE BEHOLDER


3/98

Examples of Dual Dso!"e!s:Examples of Dual Dso!"e!s:

MENTAL DISORDERSMENTAL DISORDERS S#$%op$!e&aS#$%op$!e&a B'pola!B'pola!

S#$%oa(e#)*eS#$%oa(e#)*e Ma+o! Dep!esso&Ma+o! Dep!esso& Bo!"e!l&eBo!"e!l&e

,e!so&al)-,e!so&al)-

,os) T!auma)#,os) T!auma)#S)!essS)!ess So#al ,$o.aSo#al ,$o.a o)$e!so)$e!s

ADDITIONADDITIONDISORDERSDISORDERS

Al#o$olAl#o$ol

A.use/Depe&0A.use/Depe&0

o#a&e/ Amp$e)o#a&e/ Amp$e)

Opa)esOpa)es

Ma!+ua&aMa!+ua&a

,ol-su.s)ae,ol-su.s)ae#om.&a)o&s#om.&a)o&s

,!es#!p)o& "!u1s,!es#!p)o& "!u1s


4/98

Dual Dso!"e!s fo!Dual Dso!"e!s fo!

E*e!-o&e2E*e!-o&e2

If apple" )o all #ases3 Te!m $as &o mea&&1If apple" )o all #ases3 Te!m $as &o mea&&1

4e1 Sp"e! p$o.a a&" 5Ru&&&1 A""#)o&674e1 Sp"e! p$o.a a&" 5Ru&&&1 A""#)o&67

Bo)$ Me&)al a&" A""#)o& Dso!"e!s &ee" )o .eBo)$ Me&)al a&" A""#)o& Dso!"e!s &ee" )o .e

o*e! )$!es$ol"o*e! )$!es$ol"

,e!so&al)- Dso!"e!s3 o)$e! )$a& Bo!"e!l&e &o),e!so&al)- Dso!"e!s3 o)$e! )$a& Bo!"e!l&e &o)

usuall- #ou&)e"usuall- #ou&)e"

Su.s)ae I&"u#e" Dso!"e!s #ause "a1&os)#Su.s)ae I&"u#e" Dso!"e!s #ause "a1&os)#

#o&fusoo&fuso&


5/98

HARATERISTIS OF THE DUAL DIAGNOSISHARATERISTIS OF THE DUAL DIAGNOSIS

LIENT IN 8ING OUNTY9LIENT IN 8ING OUNTY9 Res ;


6/98

S-s)ems ,!o.lemsS-s)ems ,!o.lems

D(e!e&) La=s9#omm)me&)/#o&>"0D(e!e&) La=s9#omm)me&)/#o&>"0

D(e!e&) fu&"&100au")s e)#D(e!e&) fu&"&100au")s e)#

D(e!e&) pe!so&&elD(e!e&) pe!so&&el

D(e!e&) )!a&&1D(e!e&) )!a&&1

D(e!e&) #e!)>#a)o&D(e!e&) #e!)>#a)o& D(e!e&) s)esD(e!e&) s)es

D(e!e&) No!msD(e!e&) No!ms


7/98

T$e Fou! ?ua"!a&) F!ame=o!@ fo!T$e Fou! ?ua"!a&) F!ame=o!@ fo!

o'O##u!!&1 Dso!"e!so'O##u!!&1 Dso!"e!s

A fou!'ua"!a&)A fou!'ua"!a&)#oep)ual f!ame=o!@#oep)ual f!ame=o!@)o 1u"e s-s)ems)o 1u"e s-s)ems&)e1!a)o& a&"&)e1!a)o& a&"

!esou!#e allo#a)o& &!esou!#e allo#a)o& &)!ea)&1 &"*"uals)!ea)&1 &"*"uals=)$ #o'o##u!!&1=)$ #o'o##u!!&1"so!"e!s"so!"e!s4NASMH,D3NASADAD34NASMH,D3NASADAD3


8/98

DOUBLE TROUBLEDOUBLE TROUBLE

Hall 77 Poor out-pt attendance, discontinue RxAlterman 85 More mood changes, intensive staffing olomon 8! More noncompliance, arrests afer 87 "ver t#ice hosp$ rate and criminal %ehav &ra'e 8( More hostilit), noncompliance *ar%ee 8( More ps)ch s)mptoms +)ons 8( More noncompliance, R, ail, rehosp$ .hen (/ 0orse treatment course


9/98

Bu) =$a) a.ou)Bu) =$a) a.ou) NONNON' se*e!el-' se*e!el-

me&)all- ll #o'o##u!!&1 p)s2me&)all- ll #o'o##u!!&1 p)s2 L@e & A""#)o& T!ea)me&) se))&1sL@e & A""#)o& T!ea)me&) se))&1s

L@e & !m&al us)#e se))&1sL@e & !m&al us)#e se))&1s

L@e & ,!ma!- a!e Se))&1sL@e & ,!ma!- a!e Se))&1s

L@e & ERs3 espe#all- =)$ su#"al p)sL@e & ERs3 espe#all- =)$ su#"al p)s

The new TIP will bring more focus onThe new TIP will bring more focus onthese populationsthese populations


10/98

L@el$oo" of a Su#"e A))emp)L@el$oo" of a Su#"e A))emp)

Rs@ Fa#)o!Rs@ Fa#)o!

o#a&e useo#a&e use

Ma+o! Dep!esso&Ma+o! Dep!esso&

Al#o$ol useAl#o$ol use Sepa!a)o& o! D*o!#eSepa!a)o& o! D*o!#e

NIMH/NIDANIMH/NIDA

I!ease" O""s OfI!ease" O""s Of

A))emp)&1A))emp)&1

Su#"eSu#"e

J )mes mo!e l@el-J )mes mo!e l@el-

K )mes mo!e l@el-K )mes mo!e l@el-

; )mes mo!e l@el-; )mes mo!e l@el-

)mes mo!e l@el- )mes mo!e l@el-

EA EALUATIONEA EALUATION


11/98

Double "roubleDouble "rouble::

RELATIONSHI, OF ALOHOL DRUG ,ROBLEMSRELATIONSHI, OF ALOHOL DRUG ,ROBLEMS

TO SEERE SUIIDALITY 4&3


12/98

D!u1 I&"u#e" ,s-#$opa)$olo1-D!u1 I&"u#e" ,s-#$opa)$olo1-

D!u1 S)a)esD!u1 S)a)es W)$"!a=alW)$"!a=al

A#u)eA#u)e

,!o)!a#)e",!o)!a#)e"

I&)ox#a)o&I&)ox#a)o&

$!o Use$!o Use

S-mp)om G!oupsS-mp)om G!oups Dep!esso&Dep!esso& A&xe)-A&xe)-

,s-#$oss,s-#$oss

Ma&aMa&a

Rou&sa*lle


13/98

we ve- on reva ence o - n e&en en oo anwe ve- on reva ence o - n e&en en oo anAn'iety Disorders A(ong Res&ondents with DM-$%An'iety Disorders A(ong Res&ondents with DM-$%

ubstance Use Disorders Who ought "reat(ent in the #astubstance Use Disorders Who ought "reat(ent in the #ast

)* Months)* Months

DisorderDisorder Res&ondents! + ,Res&ondents! + ,"hose With Any Alcohol Use Disorder ,/.0)+1"hose With Any Alcohol Use Disorder ,/.0)+1

A&- moo" "so!"e!A&- moo" "so!"e! 23.4523.45 4K074K07

Ma+o! Dep!esso&Ma+o! Dep!esso& 0P0P 4K074K07

D-s)$-maD-s)$-ma 00 40K740K7

Ma&aMa&a 0PJ0PJ 40;740;7H-poma&aH-poma&a 00 407407

A&- a&xe)- "so!"e!A&- a&xe)- "so!"e! 66.6066.60 4K074K07

,a "so!"e!,a "so!"e!

W)$ a1o!ap$o.aW)$ a1o!ap$o.a K0K0 40PK740PK7

W)$ou) a1o!ap$o.aW)$ou) a1o!ap$o.a


14/98

we ve- on reva ence o - n e&en en oo anwe ve- on reva ence o - n e&en en oo anAn'iety Disorders A(ong Res&ondents with DM-$%An'iety Disorders A(ong Res&ondents with DM-$%

ubstance Use Disorders Who ought "reat(ent in the #astubstance Use Disorders Who ought "reat(ent in the #ast

)* Months)* Months

DisorderDisorder Res&ondents! + ,Res&ondents! + ,"hose With Any Drug Use Disorder ,)6.)3+1"hose With Any Drug Use Disorder ,)6.)3+1

A&- moo" "so!"e!A&- moo" "so!"e! 43.6)43.6) 4P0;J74P0;J7

Ma+o! Dep!esso&Ma+o! Dep!esso& KK0JKK0J 4J0;74J0;7

D-s)$-maD-s)$-ma P0


15/98

4! of social

an"iety disorder

patients havepanic disorder##

$%! to &$! of panic disorder

patients have depression'

((! of social

an"iety disorder

patients have )CD##

&*! of )CD

patients have

depression#

*%! of social an"iety

disorder patients havedepression

o(or y oyDe&ression and An'ietyDe&ression and An'iety

DisordersDisorders

Depression

)CD

Social

+n"iety

Disorder

Panic

Disorder

H,-HL.

C)MM)0

H,-HL.

C)M)12,D


16/98

Diagnostic Criteria forDiagnostic Criteria for

#anic Attac7#anic Attac7

Palpitations3 pounding

heart

Sweating rembling or sha5ing

+dapted with permission from +merican Psychiatric +ssociation6 Diagnostic and Statistical

Manual of Mental Disorders, 4th ed6 (46

+ discreet period of intense fear or discomfortin which 4 or more of the following symptoms

developed abruptly and reached a pea5 within

(% minutes7


17/98

Diagnostic Criteria forDiagnostic Criteria for

#anic Attac7 Continued#anic Attac7 Continued Di88iness Chills or hot flushes

9eelings of unreality 9ear of losing

control or goingcra8y

9ear of dying Paresthesias

Cho5ing feeling

Smothering or

shortness of breath Chest pain or

discomfort

+bdominal distress


18/98

9atigue

-astro:intestinal

Symptoms

S)M+,C

S.MP)MS

Headache

Chest Pain

Di88iness

o(atic y(&to(s $no(aticy(&to(s $n

#anic Disorder#anic Disorder


19/98

8uality of 9ife in #anic Disorder8uality of 9ife in #anic Disorder

!

Mar'o#it6 et al$Arch Gen Psychiatry. (8(4!9(84$

Marital Discord

;past < wee5s=

>se )f ?1

;past year=9inancial

Dependence

;welfare ordisability=

i

i


20/98

American Ps)chiatric Association$ &iagnostic and tatistical Manual of Mental &isorders,4th ed$ ((4$

DM-$% DiagnosticDM-$% Diagnostic

Criteria for #"DCriteria for #"D

?"posure to a traumatic event in which?"posure to a traumatic event in which

the person7the person7

e"perienced3 witnessed3 or wase"perienced3 witnessed3 or was

confronted by death or serious in@ury toconfronted by death or serious in@ury toself or othersself or others

+D+D

responded with intense fear3responded with intense fear3helplessness3helplessness3

or horroror horror


21/98



ContinuedContinued SymptomsSymptoms

appear in A symptom clusters7 re:appear in A symptom clusters7 re:

e"periencing3 avoidance/numbing3e"periencing3 avoidance/numbing3

hyperarousalhyperarousal

last for B ( monthlast for B ( month

cause clinically significant distress orcause clinically significant distress orimpairment in functioningimpairment in functioning

i i i iDM $% Di

i C i i


22/98

DM-$% Diagnostic CriteriaDM-$% Diagnostic Criteria

for #"D Re-e'&eriencingfor #"D Re-e'&eriencing

Persistent re:e"periencing ofPersistent re:e"periencing of ( of the following7( of the following7

recurrent distressing recollections of eventrecurrent distressing recollections of event

recurrent distressing dreams of eventrecurrent distressing dreams of event acting or feeling event was recurringacting or feeling event was recurring

psychological distress at cues resembling eventpsychological distress at cues resembling event

physiological reactivity to cues resemblingphysiological reactivity to cues resemblingeventevent

i i C i i f


23/98

DM-$% Diagnostic Criteria forDM-$% Diagnostic Criteria for

#"D Avoidance:;u(bing#"D Avoidance:;u(bing

+voidance of stimuli and numbing of general+voidance of stimuli and numbing of generalresponsiveness indicated byresponsiveness indicated by A of the following7A of the following7 avoid thoughts3 feelings3 or conversations#avoid thoughts3 feelings3 or conversations# avoid activities3 places3 or people#avoid activities3 places3 or people# inability to recall part of traumainability to recall part of trauma

interest in activitiesinterest in activities

estrangement from othersestrangement from others restricted range of affectrestricted range of affect sense of foreshortened futuresense of foreshortened future

DM $% Di tiDM $% D

i ti


24/98

American Ps)chiatric Association$ &iagnostic and tatistical Manual of Mental &isorders, 4th

ed$ ((4$



Hy&erarousalHy&erarousal Persistent symptoms of increased arousalPersistent symptoms of increased arousal


25/98

#revalence of "rau(a and#revalence of "rau(a and

#robability of #"D#robability of #"D

0itness Accident :hreat #;

0eapon

Ph)sical

Attac'

Molestation .om%at Rape

(

$

:his pilot stud) suggests that paroxetine is an effective treatment for social anxiet) disorder in

individuals #ith comor%id alcohol pro%lems, and positive treatment effects can %e seen in as

little as 8 #ee's$ Further stud) is #arranted to investigate its utilit) in helping affected

individuals reduce alcohol use$ .op)right /33 0ile)-+iss, Cnc$
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136


34/98

W$- a!e&) A&)"ep!essa&)s mo!eW$- a!e&) A&)"ep!essa&)s mo!e

e(e#)*e & a""#)o&s pa)e&)s2e(e#)*e & a""#)o&s pa)e&)s2

,s-#$a)!# ou)#omes:,s-#$a)!# ou)#omes: A&)"ep!essa&)s o&l- .ea) pla#e.o .- a&-=a- &A&)"ep!essa&)s o&l- .ea) pla#e.o .- a&-=a- &

NON a""#)sNON a""#)s

S)u"- pa)e&)s also 1e) 5a""#)o& !x6S)u"- pa)e&)s also 1e) 5a""#)o& !x6 Ma-.e a""#)o& !x s mo!e a&)'"ep3 a&) a&x )$a& =eMa-.e a""#)o& !x s mo!e a&)'"ep3 a&) a&x )$a& =e

)$&@9*% S#$u#@) ; ' )$&@9*% S#$u#@) ; ' T$s s poo!l- s)u"e"9ma-.e .e))e! =)$ s)epT$s s poo!l- s)u"e"9ma-.e .e))e! =)$ s)ep Su. I&"u#e" #!)e!a a!e =!o&1Su. I&"u#e" #!)e!a a!e =!o&1

A""#)o&s ou)#omesA""#)o&s ou)#omes Me"s )a@e fo#us o( so.!e)-Me"s )a@e fo#us o( so.!e)- Me"s !e&fo!#e so.!e)-Me"s !e&fo!#e so.!e)- us) "o&) =o!@ fo! )$sus) "o&) =o!@ fo! )$s

Al#o$ol l& Exp Res0 Fe.CP47:'Al#o$ol l& Exp Res0 Fe.CP47:'


35/98

#o o p es e.C P4 7 p C 4 7

00

Concurrent alcoholism and social an"iety disorder7 a first step toward

developing effective treatments6

1andall CL3 homas S3 hevos +K6

:he present stud) investigated #hether simultaneous treatment of social pho%ia and alcoholism, compared

#ith treatment of alcoholism alone, improved alcohol use and social anxiet) for clients #ith dual diagnoses

of social anxiet) disorder and alcohol dependence$

M:H"&9 :he design #as a t#o-group, randomi6ed clinical trial that used / #ee's of individual

cognitive %ehavioral therap) for alcoholism onl) =n B 44> or concurrent treatment for %oth alcohol and social

anxiet) pro%lems =n B 4(>$ "utcome data #ere collected at the end of / #ee's of treatment and at 9((-35$Related Articles,+in's

+ cognitive:behavioral treatment for incarcerated women with

substance abuse disorder and posttraumatic stress disorder7 findings

from a pilot study6

lotnic5 C3 a@avits LM3 1ohsenow DI3 Iohnson DM6

:his preliminar) stud) evaluates the initial efficac) of a cognitive-%ehavioral treatment,

ee'ing afet), as an adunct to treatment-as-usual in an uncontrolled pilot stud) of

incarcerated #omen #ith current J& and comor%id P:&$

"f the 7 incarcerated #omen #ith P:& and J& #ho received ee'ing afet) treatmentand had outcome data,

results sho# that nine ;$A!= no longer met criteria for PSD at the end of

treatmentN at a followup A months later3 seven ;4&!= still no longer met criteria

for PSD

Additionall), there #as a significant decrease in P:& s)mptoms from inta'e to posttreatment,#hich #as maintained at the


37/98

a& eou!a1&1 su.s)ae a.use pa)e&)s )oa& eou!a1&1 su.s)ae a.use pa)e&)s )o

pa!)#pa)e & self'$elp 1!oups !e"u#e "ema&" fo!pa!)#pa)e & self'$elp 1!oups !e"u#e "ema&" fo!

$eal)$ #a!e2$eal)$ #a!e2

A uas'expe!me&)al s)u"-A uas'expe!me&)al s)u"-

&K3 -ea! follo='up&K3 -ea! follo='up Hump$!e-s e) al 00Hump$!e-s e) al 00

Ou)p) I&p) "a-s A.s)&eeOu)p) I&p) "a-s A.s)&ee

s)ss)s Ra)es Ra)es

S)ep 0 0P KP0 S)ep 0 0P KP0

o1 Be$ J0o1 Be$ J0

Q all p 0 QQ JK $1$e! #os) fo! BTQ all p 0 QQ JK $1$e! #os) fo! BT


38/98

Dual S#!ee&&1:Dual S#!ee&&1:

)$e 5Dual a1e6999990eas-3 .u) &o "a)a)$e 5Dual a1e6999990eas-3 .u) &o "a)a

ASAM p) pla#eme&)99900&ee"s expe!ee3 l))le o! &oASAM p) pla#eme&)99900&ee"s expe!ee3 l))le o! &o

"a)a"a)a

ASI ps-#$999999990s$o!)3 a*ala.le3 1oo" s#!ee&&13ASI ps-#$999999990s$o!)3 a*ala.le3 1oo" s#!ee&&131oo" "a)a1oo" "a)a

Be#@3 u&13 Ham D e)#900eas-3 1oo" "a)a3 ma- .e lm)e"Be#@3 u&13 Ham D e)#900eas-3 1oo" "a)a3 ma- .e lm)e"

B!ef S-mp)om I&*e&)o!-9eas-3 .!oa" s-mp)om mxB!ef S-mp)om I&*e&)o!-9eas-3 .!oa" s-mp)om mx

O)$e!s99999999999see &e= o'o##u!!&1 TI, & 'O)$e!s99999999999see &e= o'o##u!!&1 TI, & '

KK


39/98

55Dual AGE6 ?UESTIONSDual AGE6 ?UESTIONS

u) Do=& 4o! s)oppe"7u) Do=& 4o! s)oppe"7 Be#ause me&)al s-mp)oms =o!se&e"Be#ause me&)al s-mp)oms =o!se&e"

Be#ause MH "o#)o! o! )$e!aps) su11es)e"Be#ause MH "o#)o! o! )$e!aps) su11es)e"

A&&o-e" =$e& "!u1/al#0 use "s#usse"A&&o-e" =$e& "!u1/al#0 use "s#usse" A&&o-e"3 a&xous o! a&1!-39 >1$)s =$e& us&1A&&o-e"3 a&xous o! a&1!-39 >1$)s =$e& us&1

A"m))e" )o ER o! $osp)al fo! ps-#$ =$e& us&1 o! &o)A"m))e" )o ER o! $osp)al fo! ps-#$ =$e& us&1 o! &o)

ADHD =$e& #$l"ADHD =$e& #$l"

Gul)- a.ou) useGul)- a.ou) use Gul)-3 "ep!esse"3 su#"al =$e& us&1 o! &o)Gul)-3 "ep!esse"3 su#"al =$e& us&1 o! &o)

E*e! ma"e a su#"e a))emp) =$e& us&1 o! &o)E*e! ma"e a su#"e a))emp) =$e& us&1 o! &o)


40/98

AGE ?ues)o&sAGE ?ues)o&s

E-e ope&e!: )a@e& "!&@ o! "!u1 & AM )o feelE-e ope&e!: )a@e& "!&@ o! "!u1 & AM )o feel.e))e!.e))e!Ta@e& a "!&@ o! "!u1 )o .lo) ou) s-mp)omsTa@e& a "!&@ o! "!u1 )o .lo) ou) s-mp)omsTa@e& "!&@ o! "!u1 =)$ ps-#$ me"Ta@e& "!&@ o! "!u1 =)$ ps-#$ me" No) )a@e& me"s .e#ause of us&1 "!u1/al#No) )a@e& me"s .e#ause of us&1 "!u1/al#

4fo!1o)3 a*o" mx&13 e)#074fo!1o)3 a*o" mx&13 e)#07

W$a) a!e o! !easo&s -ou use al#/"!u1s2W$a) a!e o! !easo&s -ou use al#/"!u1s2 W$a) a!e o! !easo&s -ou m1$) =a&) )oW$a) a!e o! !easo&s -ou m1$) =a&) )o

s)op o! #u) "o=&2s)op o! #u) "o=&2


41/98

Me"#a)o&sMe"#a)o&s

Esse&)al )o T!ea)me&) of Se*e!el-Esse&)al )o T!ea)me&) of Se*e!el-

Me&)all- IllMe&)all- Ill

Su.s)ae Use a&" No)'Ta@&1 Me"s a!e )$e Su.s)ae Use a&" No)'Ta@&1 Me"s a!e )$e )op !easo&s fo! De'omp)op !easo&s fo! De'omp

S$oul" .e pa!) of #ou!) o!"e!sS$oul" .e pa!) of #ou!) o!"e!s

Mo&)o!e" .- ase ma&a1e!s3 &u!ses3 "o#)o!sMo&)o!e" .- ase ma&a1e!s3 &u!ses3 "o#)o!s

Fo! Dep/A&x3 less #lea!Fo! Dep/A&x3 less #lea! ,e!so&al expe!ee s$o=s maxm%&1 s)ep,e!so&al expe!ee s$o=s maxm%&1 s)ep

AND use of me"s s .es) !xAND use of me"s s .es) !x


42/98

I) ma-I) ma- &o)&o).e )$a) )$e me"4s7.e )$a) )$e me"4s7

s)oppe" =o!@&13 .u)99s)oppe" =o!@&13 .u)99

T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me"

T$e pa)e&) s)oppe" )$e me" AND use"T$e pa)e&) s)oppe" )$e me" AND use"

"!u1s a&"/o! al#o$ol9000"!u1s a&"/o! al#o$ol9000 OR lo=e!e" )$e me" a&" use"9OR lo=e!e" )$e me" a&" use"9

OR use" o& )op of )$e me"90OR use" o& )op of )$e me"90

OR use" )=#e )$e "ose o& o&e "a- a&"OR use" )=#e )$e "ose o& o&e "a- a&"&o)$&1 )$e &ex)90&o)$&1 )$e &ex)90

S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)

MSE "es)!u#)*e0MSE "es)!u#)*e0


43/98

Ho= )o use AA as a )!ea)me&)Ho= )o use AA as a )!ea)me&)

pa!)&e!pa!)&e!

0 8&o= some)$&1 a.ou) AA3 )s $s)o!-30 8&o= some)$&1 a.ou) AA3 )s $s)o!-3p!esee & -ou! #ommu&)-3 s)!u#)u!e a&"p!esee & -ou! #ommu&)-3 s)!u#)u!e a&"#o&)e&)#o&)e&)

0 Helpful Rea"&1s:0 Helpful Rea"&1s: B!o=&: A ps-#$olo1#al *e= of )$e s)epsB!o=&: A ps-#$olo1#al *e= of )$e s)eps AA:AA: AA fo! )$e me"#al p!a#))o&e!AA fo! )$e me"#al p!a#))o&e!C a&"C a&"

T$e AA mem.e! a&" me"#a)o&sT$e AA mem.e! a&" me"#a)o&s T=el*e S)ep Fa#l)a)o& T$e!ap- Ma&ual'T=el*e S)ep Fa#l)a)o& T$e!ap- Ma&ual'

,!o+e#) Ma)#$3 NIAAA =e. s)e,!o+e#) Ma)#$3 NIAAA =e. s)e Fo!ma&: 5O&e AA Me)&1 "oes&) >) all6Fo!ma&: 5O&e AA Me)&1 "oes&) >) all6


44/98

)ne year +2S,?C? was predicted by9

AA involvement ="RB/$(>, = nB

not having pro-drin'ing influences in oneLs net#or' ="RB3$7

having support for reducing consumption from people met

in AA =versus no support "RB$

,n contrast3 having support from non:++ members was

not a significant predictor of abstinence6

?as'utas9 Addiction /33/


45/98

Dou.le T!ou.le Re#o*e!- 4DTR7Dou.le T!ou.le Re#o*e!- 4DTR7

Ou)#omesOu)#omes

Mem.e!s of K DTR 1!oups 4&K7 Ne= Yo!@ )-3Mem.e!s of K DTR 1!oups 4&K7 Ne= Yo!@ )-3 -ea! ou)#omes -ea! ou)#omes

D!u1/al#o$ol a.s)&ee PK a) .asel&e3D!u1/al#o$ol a.s)&ee PK a) .asel&e3!ease" )o a) follo='up0!ease" )o a) follo='up0

Mo!e a))e&"ae .e))e! Me"#a)o& a"$e!ee3Mo!e a))e&"ae .e))e! Me"#a)o& a"$e!ee3

Be))e! Me"#a)o& a"$e!ee less $osp)al%a)o&Be))e! Me"#a)o& a"$e!ee less $osp)al%a)o&

Ma1u!a A"" Be$ 3 ,s-#$ Se!* Ma1u!a A"" Be$ 3 ,s-#$ Se!*


46/98

Dual Dep/A&x RV pla&Dual Dep/A&x RV pla&

D(e!e&)al DxD(e!e&)al Dx s)ep fa#l)a)o& s)ep fa#l)a)o&

Me"s f &"#a)e" 4 a&" I of)e& use )$em7Me"s f &"#a)e" 4 a&" I of)e& use )$em7 s)s:s)s:

Res /=ee@ 4 s)ep fa#l a&" me"s7Res /=ee@ 4 s)ep fa#l a&" me"s7 AA x =ee@ o!


47/98

Lo= me&)al ll&ess/H1$ a""#)o&s ou)p)Lo= me&)al ll&ess/H1$ a""#)o&s ou)p)

1e)s1e)s

Cn most MH.s9Cn most MH.s9 M& visit I < monthsM& visit I < months .M visit I / #'sfocus on A&+s.M visit I / #'sfocus on A&+s Ma)%e dual dx group -/ hrs;#'Ma)%e dual dx group -/ hrs;#' +imited expectations of recover)+imited expectations of recover) Pschotherap) time N 3-/ hrs #ee'Pschotherap) time N 3-/ hrs #ee'

Cn the most Addictions C"PsCn the most Addictions C"Ps M& visit ; < months, often careM& visit ; < months, often care .M 9 I / #'s$focus on u% use, J toxs.M 9 I / #'s$focus on u% use, J toxs C"P group < hrs-


48/98

Report Questions Ability of National Treatment Infrastructure to Deliver Quality Care

301-405-9770 (voice) 301-403-8342 (fax) [email protected]!.e!u """.cesar.u!.e!u

CESAR #A$ is su%%or&e! ' *+, 199-1002 a"ar!e! ' &/e .S. e%ar&e& of us&ice &/rou/ &/e overor6s *ffice of Crie Co&ro a! reve&io. CESAR

Percentage

of Programs

Closed or Stopped

Services

Reorganized Director in

Position Less Than

One ear

!o "nformation

Services# $%mail#

or &oicemail

09

209

409

-09

809

1009

1'(

2'(

'4(

2)(

S*RCE: A!a%&e! ' CESAR fro &/e ;c


49/98

Ne= Issues & Me"#a)o&s fo!Ne= Issues & Me"#a)o&s fo!

o'o##u!!&1 A""#)o& a&"o'o##u!!&1 A""#)o& a&"

Me&)al Dso!"e!sMe&)al Dso!"e!s

R#$a!" Res MDR#$a!" Res MD


50/98

Me"#a)o& mo&)o!&1 a&"Me"#a)o& mo&)o!&1 a&"

mo)*a)&1mo)*a)&1

?no# #ho is on #hat and #hat for?no# #ho is on #hat and #hat for

?no# the prescri%er if possi%le?no# the prescri%er if possi%le

it in on med sessions onsiteit in on med sessions onsite :al' to off-site doctor or nurse:al' to off-site doctor or nurse P1? problemOOOP1? problemOOO

?no# something a%out meds?no# something a%out meds

A::. :ech transfer centers summar)A::. :ech transfer centers summar) @e# ."& :CP = &ec 34>@e# ."& :CP = &ec 34> @CMH #e% site, @AMC #e% site@CMH #e% site, @AMC #e% site


51/98

Me"#a)o&s: #ou&selo!sMe"#a)o&s: #ou&selo!s

!ole!ole As' the pt a%out 9As' the pt a%out 9

.ompliance.ompliance OOsometimes people forget their medicationsho# often does thissometimes people forget their medicationsho# often does this

happen to )ouQ ie D not ta'inghappen to )ouQ ie D not ta'ing

ffectivenessffectiveness OOho# #ell do )ou thin' the meds are #or'ingho# #ell do )ou thin' the meds are #or'ing #hat do )ou notice#hat do )ou notice here is #hat C noticehere is #hat C notice

ide ffects$ide ffects$ OO are )ou having an) side effects to the medicationare )ou having an) side effects to the medication #hat are the)#hat are the) have )ou told the prescri%erhave )ou told the prescri%er do )ou need help #ith tal'ing to the presci%erdo )ou need help #ith tal'ing to the presci%er


52/98

Me"#a)o&s90po)e&)alMe"#a)o&s90po)e&)al

p!o.lemsp!o.lems

a& !e&fo!#e a""#)o& "e&al f !e#o*e!- s &o)a& !e&fo!#e a""#)o& "e&al f !e#o*e!- s &o)&)e1!a)e" a&" suppo!)e"9esp .- )$e&)e1!a)e" a&" suppo!)e"9esp .- )$ep!es#!.e!004 so =o!@ =)$ )$em7p!es#!.e!004 so =o!@ =)$ )$em7

a& .e expe&s*e3 #ause s"e e(e#)s3 #oul" .ea& .e expe&s*e3 #ause s"e e(e#)s3 #oul" .euse" & o*e!"ose0use" & o*e!"ose0 Eum.e! )$e p) =)$ see&1 MD3 o! me&)alEum.e! )$e p) =)$ see&1 MD3 o! me&)al

$eal)$ s-s)em3 #os)3 #o&*e&ee e)#90e ma@e$eal)$ s-s)em3 #os)3 #o&*e&ee e)#90e ma@esu!e )$e- a!e !eall- &e#essa!-0su!e )$e- a!e !eall- &e#essa!-0

A#)*e pa!)#pa)o& & !e#o*e!- #a& .e .o)$A#)*e pa!)#pa)o& & !e#o*e!- #a& .e .o)$a&)"ep a&" a&)a&x9.u) f )$ese p!o.lemsa&)"ep a&" a&)a&x9.u) f )$ese p!o.lems#o&)&ue3 o! "s!up) !e#o*e!-3 me"s s$oul" .e#o&)&ue3 o! "s!up) !e#o*e!-3 me"s s$oul" .e#o&s"e!e"#o&s"e!e"


53/98

A&)ps-#$o)#sA&)ps-#$o)#s

Al#o$ol l& Exp Res KAl#o$ol l& Exp Res K


54/98

Al#o$ol l& Exp Res0 KAl#o$ol l& Exp Res0 KMa-C;4P7:J'KP0Ma-C;4P7:J'KP0

+ double:blind3 placebo:controlled study of olan8apine in the

treatment of alcohol:dependence disorder6

-uardia I3 Segura L3 -on8alvo 23 ,glesias L3 1oncero C3 Cardus M3 Casas M6

M:H"&9 A total of !3 alcohol-dependent patients #ere assigned to / #ee'sL treatment

#ith either olan6apine or place%o$ :he primar) varia%le relapse to heav) drin'ing rate #as

evaluated %) means of intention-to-treat anal)ses$ Alcohol consumption, craving, adverse

events, and changes in the %iochemical mar'ers of heav) drin'ing and possi%le toxicit) #erealso evaluated$

RJ+:9 0e did not find significant differences in the survival anal)sis %et#een place%o and

olan6apine-treated patients =?aplan-Meier log ran' B 3$4!, df B , p B 3$53>$ leven =

patients treated #ith olan6apine relapsed compared #ith ( =/(D> of those receiving place%o

=chi B 3$5$ Although some adverse events =#eight gain, increased appetite,

dro#siness, constipation, and dr) mouth> #ere found more freIuentl) in the olan6apine group,differences did not reach statistical significance in comparison #ith the place%o group$

."@.+JC"@9 Ge found no differences in relapse rate or other drin5ing variables

when comparing olan8apine with placebo:treated patients6

l& ,s-#$op$a!ma#ol0 l& ,s-#$op$a!ma#ol0


55/98

- pFe.C47: and su%stance use disorder$ "f these 58 patients, 4< #ere

%eing treated #ith clo6apine at the time of the surve) the remaining 5 patients had

discontinued clo6apine %efore the surve)$

More than J$! of the patients who were active substance users at the time of

initiation of treatment with clo8apine decreased their substance use over the

course of clo8apine administration$For patients #ho continued treatment #ith

clo6apine up to the present, the decrease in su%stance use #as strongl) correlated

#ith a decrease in glo%al clinical s)mptoms$

S#$%op$! Res0 K Fe. CJJ4'7:P'P0S#$%op$! Res0 K Fe. CJJ4'7:P'P0


56/98

9irst episode schi8ophrenia:related psychosis and substance use disorders7

acute response to olan8apine and haloperidol6

-reen +,3 ohen M93 Hamer 1M3 Stra5ows5i SM3 Lieberman I+3 -lic5 ,3 Clar5 GSN H-DH 1esearch -roup6

M:H"&9 :he stud) involved /!/ patients$ Patients #ith a histor) of su%stance

dependence #ithin month prior to entr) #ere excluded$

RJ+:9 "f this sample, (7 = had a lifetime diagnosis of su%stance use disorder

=J&> of these 74 =/8D of the total> had a lifetime canna%is use disorder =.J&> and 54 =/D> had

a lifetime diagnosis of alcohol use disorder =AJ&>$

hose with C>D had a lower age of onset than those without6Patients with S>D were more li5ely to be men6Patients with S>D had more positive symptoms and fewer negative symptoms than

those without S>D3 and they had a longer duration of untreated psychosis6he (D6Patients with +>D were less li5ely to respond to olan8apine than those without +>D6

&C.JC"@9 :hese data suggest that first-episode patients are Iuite li'el) to have comor%id

su%stance use disorders, and that the presence of these disorders ma) negativel) influence

response to antips)chotic medications, %oth t)pical and at)pical antips)chotics, over the first /

#ee's of treatment$

p 4 7p

*ipolar &isord$ /33/&ec4=!>943!-

Related Articles,+in's
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12519101http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12519101


57/98

&ec4=!>943!-$

uetiapine in bipolar disorder and cocaine dependence6

2rown ?S3 e@te5 +3 Perantie DC3 2obadilla L6

M:H"&9 "pen-la%el, add-on, Iuetiapine therap) #as examined for / #ee's in 7

outpatients #ith %ipolar disorder and cocaine dependence$ u%ects #ere evaluated #ith a

structured clinical intervie# Hamilton &epression Rating =H&R>, Eoung Mania Rating

=EMR>, *rief Ps)chiatric Rating =*PR> scales and .ocaine .raving uestionnaire =..>$

Jrine samples and self-reported drug use #ere also o%tained$ &ata #ere anal)6ed using a last

o%servation carried for#ard method on all su%ects given medication at %aseline$

RJ+:9

Significant improvement from baseline to e"it was observed in HD1S3 .M1S3 2P1S and

CC scores ;p or %6%$=6

Dollars spent on cocaine and days/wee5 of cocaine use decreased non:significantly3

and urine drug screens did not change significantly from baseline to e"it6

uetiapine #as #ell tolerated, #ith no su%ects to our 'no#ledge discontinuing %ecause of

side-effects$ ."@.+JC"@9 :he use of Iuetiapine #as associated #ith su%stantial

improvement in ps)chiatric s)mptoms and cocaine cravings$ :he findings are promising and

suggest larger controlled trials of Iuetiapine are needed in this population$

S#$%op$! Res0 Ma!S#$%op$! Res0 Ma!


58/98

CJ47:;'P0CJ47:;'P0

+lcohol and cannabis use in schi8ophrenia7 effects of clo8apine vs6risperidone6

-reen +,3 2urgess ?S3 Dawson 13 immet S3 Strous 1D6

M:H"&9 :his stud) involved retrospective assessment of a%stinence

=cessation of alcohol and canna%is use> in 4 patients treated #ith either

risperidone =nB8> or clo6apine =nB


59/98

Eu! ,$a!ma#ol0Eu! ,$a!ma#ol0

Ma- Ma-, %ut long-lasting #hen the dose #as increased to $3

mg;'g that also %loc's dopamine &=/> receptors$

.an 2 Ps)chiatr)$ /33/ep47=7>9!7 5

Related Articles,+in's
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12355680http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12355680


60/98

ep47=7>9!7-5$

1isperidone decreases craving and relapses in individuals withschi8ophrenia and cocaine dependence6

Smelson D+3 Losonc8y M93 Davis CG3 Kaune M3 Gilliams I3 iedonis D6

"*2.:CK9 :o examine the efficac) of at)pical neuroleptics for decreasing craving and drug relapses

during protracted #ithdra#al in individuals duall) diagnosed #ith schi6ophrenia and cocaine dependence$

M:H"&9 0e conducted a !-#ee', open-la%el pilot stud) comparing risperidone #ith t)pical neuroleptics

in a sample of #ithdra#n cocaine-dependent schi6ophrenia patients$

RJ+:9 Preliminary results suggest that individuals treated with risperidone had significantly

less cue:elicited craving and substance abuse relapses at study completion6 9urther3 they showed a

trend toward a greater reduction in negative and global symptoms of schi8ophrenia$

."@.+JC"@9 At)pical neuroleptics ma) help reduce craving and relapses in this population$ Futureresearch should include more rigorous dou%le-%lind place%o-controlled studies #ith this class of

medications$

C bid b t Ab A i t dCo(orbid ubstance Abuse Associated


61/98

Co(orbid ubstance Abuse AssociatedCo(orbid ubstance Abuse Associated

With ;onco(&liance in chi>o&hreniaWith ;onco(&liance in chi>o&hrenia

Nea!l- $alf of all pa)e&)s &Nea!l- $alf of all pa)e&)s &

a p!ospe#)*e K'-ea! s)u"-a p!ospe#)*e K'-ea! s)u"-

4N


62/98

I) ma- &o) .e )$a) )$eI) ma- &o) .e )$a) )$e

me"4s7 s)oppe" =o!@&13me"4s7 s)oppe" =o!@&13

.u)99.u)99T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me" AND use"T$e pa)e&) s)oppe" )$e me" AND use"

"!u1s a&"/o! al#o$ol9000"!u1s a&"/o! al#o$ol9000

OR lo=e!e" )$e me" a&" use"9OR lo=e!e" )$e me" a&" use"9 OR use" o& )op of )$e me"90OR use" o& )op of )$e me"90

OR use" )=#e )$e "ose o& o&e "a- a&"OR use" )=#e )$e "ose o& o&e "a- a&"

&o)$&1 )$e &ex)90&o)$&1 )$e &ex)90 S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)

MSE "es)!u#)*e0MSE "es)!u#)*e0


63/98

RIS,ERDALRIS,ERDALONSTAONSTAXX

I&+e#)o& 8) ompo&e&)sI&+e#)o& 8) ompo&e&)seedle Proeedle ProQQDeviceDevice

Safety eedleSafety eedleSmartSiteSmartSiteSS

+ccess+ccess

DeviceDevice

1isperidone1isperidone

MicrospheresMicrospheres

+Rueous+Rueous

DiluentDiluent

+ssembled+ssembled

1,SP?1D+L1,SP?1D+LQQC)S+C)S+

PR. approved #ith

changes9 ;3;3

PR. approved #ith

changes9 ;3;3$ "nthe %asis of this list, a consecutive series of !8 patients #ith 74 episodes of acute mania #ho

had %een referred for routine treatment #ere retrospectivel) assessed to determine their

eligi%ilit) for a h)pothetical %ut representative randomised controlled trial$

RJ+:9 )nly (&! of the manic episodes would Rualify for the hypothetical trial ;male

episodes


70/98

Sp!&1C47:K'PSp!&1C47:K P

he differential effects of medication on mood3 sleep disturbance3 and

wor5 ability in outpatient alcohol deto"ification6

Malcolm 13 Myric5 H3 1oberts I3 Gang G3 +nton 196

A dou%le-%lind, randomi6ed controlled trial of patients =n B meeting &M-CK

criteria for alcohol #ithdra#al and stratified %ased on detoxification histor) #ere

treated #ith carbama8epine or lora8epamfor 5 da)s on a fixed dose taperingschedule$ Mood s)mptoms improved for all su%ects regardless of medication or

detoxification histor)$

main effect favoring carbama8epine in reducing an"iety ;p %6%%%*=6

main effect of medication on sleep that again favored carbama8epine ;p

%6%(J&=6

Cn this stud) of outpatients #ith mild to moderate alcohol #ithdra#al,

car%ama6epine #as superior to lora6epam in reducing anxiet) and improving sleep$

Al#o$ol l& Exp Res Al#o$ol l& Exp Res


71/98

Al#o$ol l& Exp Res Al#o$ol l& Exp Res

SepCP4


72/98

Changes in use of valproate and other mood stabili8ers for patients

with schi8ophrenia from (4 to (J6

Citrome L3 Levine I3 +llingham 26

M:H"&9 For each calendar )ear from ((4 through ((8, data #ere dra#n from

a data%ase containing clinical and drug prescription information for ever) inpatient in

the adult civil facilities of the @e# Eor' tate "ffice of Mental Health$

RJ+:9 Cn ((4 a total of /!$/ percent of inpatients diagnosed as having

schi6ophrenia received a mood sta%ili6er, compared #ith 4


73/98

+d@unctive divalproe" and hostility among patients with

schi8ophrenia receiving olan8apine or risperidone6Citrome L3 Casey D?3 Daniel D-3 Go8nia5 P3 Kochan LD3 racy K+6

M:H"&9 A total of /4( inpatients #ith schi6ophrenia #ere randoml) assigned,

RJ+:9 .om%ination treatment #ith risperidone or olan6apine plus divalproex

#as associated #ith different scores on the hostilit) item of the PA@ compared

#ith antips)chotic monotherap)$

his result was not seen beyond the first wee5 of treatment3 but there was a

trend toward a difference in effect for the entire treatment period6Combination therapy had a significantly greater antihostility effect at days A

and * than monotherapy6he effect on hostility appears to be statistically independent of

antipsychotic effect on other P+SS items reflecting delusional thin5ing3a formal thought disorder3 or hallucinations6

."@.+JC"@9 &ivalproex sodium ma) %e useful as an adunctive agent in

specificall) reducing hostilit) in the first #ee' of treatment #ith risperidone or

olan6apine among patients #ith schi6ophrenia experiencing an acute ps)chotic

episode$

l& ,s-#$op$a!ma#ol0 l& ,s-#$op$a!ma#ol0 Fe.C47:'J0Fe.C47:'J0

Rela)e" A!)#les3Rela)e" A!)#les3L&@sL&@s
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943


74/98

Divalproe" sodium augmentation of haloperidol in hospitali8ed

patients with schi8ophrenia7 clinical and economic implications6Gassef ++3 Hafi8 -3 Hampton D3 Molloy M6

&ivalproex sodium has %een approved for use in treating %ipolar disorder$ Cts

usefulness in schi6ophrenia has )et to %e adeIuatel) assessed$

Compared with those who received no or delayed augmentation3 the early:augmentation group reRuired 446J! fewer inpatient days from the initiation of

haloperidol treatment6Patient response to treatment #as particularl) noted in

suspiciousness, hallucinations, unusual thought content, and emotional #ithdra#al$

?arly augmentation with valproate may reduce the length of inpatient stays

and provide substantially better therapeutic outcomes$ Ct is, ho#ever,premature to recommend changes in the standard clinical management of

schi6ophrenia on the %asis of the data provided herein, in vie# of the small sample

and open-la%el nature of the report$


75/98

&epa'ote #ith At)pical Antips)chotic9 lipids

Patients treated #ith a com%ination of &epa'ote and U)prexa experienced a

minimal increase in total cholesterol compared to the greater increase inpatients treated #ith U)prexa #hen used as monotherap)9

T


76/98

)ral topiramate for treatment of alcohol dependence7 a

randomised controlled trial6 2ohnson *A et al

M:H"&9 dou%le-%lind randomised controlled /-#ee' clinical trialcomparing oral topiramate and place%o for treatment of 53 individuals #ith

alcohol dependence$$

FC@&C@19 At stud) end, participants on topiramate, compared #ith

those on place%o, had

those of place%o, of similar magnitude to the self-reported drin'ing changes,

and highl) correlated #ith them$


77/98

opiramate for +lcohol Githdrawal7

9 Med Arh$ /33/5!=4>9/-/$

A pilot stud) of :opiramate =:opamax> in the treatment of tonic-clonic sei6ures

of alcohol #ithdra#al s)ndromes$ Rustem%egovic A, ofic , ?ro)er 1$ Anton

Pro'sch Cnstitute, Kienna, Austria$

/ patients #ith median age of 4($5 )ears and median %od) #eight of

7!$< 'g #ere treated #ith topiramate t#ice dail) for up


78/98

?ffects on weight and outcome of long:term olan8apine:

topiramate combination treatment in bipolar disorder$

:#ent)-six &iagnostic and tatistical Manual of Mental &isorders, Fourth

dition %ipolar spectrum patients received olan6apine plus topiramate cotherap) for

treatment of their manic =n B 4>, h)pomanic =n B !>, depressive =n B />, and mixed =n B

> s)mptoms for )ear$ :hree rapid c)cling patients #ere also enrolled despite %eing

euth)mic$ :hirteen =53D> patients completed the -)ear follo#-up$

*) intent-to-treat, patients significantl) improved from %aseline in

.oung Mania 1ating Scale scores ;P %6%%%(=3 Hamilton Depression 1ating Scale ;P %6%$=3 and

Modified Clinical -lobal ,mpressions for 2ip ;mania P %6%%%(3 Depression ; Ham= P %6%$3 000overall P %6%%%(=6

Most patients gained weight during the first month of combined treatment ;mean

weight gain %6* T/: %6& 5g=3 but at the (


79/98

-abapentin for the treatment of ethanol withdrawal6

oris I3 Smith L3 1ao SM3 horne DL3 9lowers I6

0e retrospectivel) report on the use of ga%apentin for ethanol #ithdra#al in 4(

patients$ :hirt)-one patients #ere treated in the outpatient program and 8 in the

general inpatient ps)chiatric unit$

Positive outcomes as evidenced by completion of gabapentin therapy were

achieved in


80/98

)pen pilot study of gabapentin versus tra8odone to treat insomnia in

alcoholic outpatients6

Karam:Hage M3 2rower KI6

Alcohol-dependent outpatients #ith persisting insomnia #ere treated #ith either ga%apentin ortra6odone$ Patients #ere assessed at %aseline and after 4-! #ee's on medication using the

leep Pro%lems uestionnaire =P>$ "f 55 cases initiall) treated, (D dropped out due to

morning dro#siness$ "f the remaining 53 cases, at %edtime and ! #ere treated #ith tra6odone =35 X;- 57 mg> at

%edtime$

2oth groups improved significantly on the SP but the gabapentin group improvedsignificantly more than the tra8odone group6 Controlled studies are warranted to

replicate these findings6

Me" A!$0 KCP;47:P'J0Me" A!$0 KCP;47:P'J0


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C 4 74 7

+ study of gabapentin in the treatment of tonic:clonicsei8ures of alcohol withdrawal syndrome6

1ustembegovic +3 Sofic ?3 ahirovic ,3 Kundurovic 6

Cn this stud) for thirt) = patients #ith alcohol #ithdra#al s)ndrome, the

response to anticolvusant ga%apentin #as assessed$ :hirt) = patients#ith median age of 57$3 )ears and median %od) #eight of 7($ 'g #ere

treated #ith ga%apentin < x


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Lamotrigine in patients with bipolar disorder and cocaine dependence6

2rown ?S3 e@te5 +3 Perantie DC3 )rsula5 PI3 2obadilla L6

M:H"&9 +amotrigine #as started at a dose of /5 mg;da) =/$5 mg;da) in those ta'ing

valproic acid> and titrated to a maximum dose of , %ipolar CC

disorder =@ B 7>, or %ipolar disorder not other#ise specified =@ B >, #ith a mean X;- & age ofLS9 Significant improvement was observed in H+M:D3 .M1S3 and 2P1S scores

;p or 6%


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A&)'opa)e A""#)o& Me"sA&)'opa)e A""#)o& Me"s Harm reduction766opiatesHarm reduction766opiates

MethadoneMethadone )nly through Methadone agencies for +ddiction)nly through Methadone agencies for +ddiction Confusion when in@ury/pain/addiction co:occurrConfusion when in@ury/pain/addiction co:occurr

L++M6L++M6 Due to liver prolems ; minor= is being phased outDue to liver prolems ; minor= is being phased out

2uprenorphine2uprenorphine ot given orallyot given orally

Subo"oneSubo"one Combination of 2up plus alo"one subligualCombination of 2up plus alo"one subligual +bsorb the 2up3 not the alo"one+bsorb the 2up3 not the alo"one ,f used , then immediate Githdrawal from nalo"one,f used , then immediate Githdrawal from nalo"one

Practitioners need special D?+ W and trainingPractitioners need special D?+ W and training

Githdrawal treatmentGithdrawal treatment MethadoneMethadone 2uprenorphine2uprenorphine Clonidine TTClonidine TT

,ntrinsic +ctivity7 9ull +gonist ;Methadone=3 Partial


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:(% : :J :* :& :$ :4

%

(%


85/98

Patient dependent on short:acting opioidsF

Githdrawal symptomspresent (C,) D+. # a"s

If us&1 B,s3 oxa%epam a&" l.!umIf us&1 B,s3 oxa%epam a&" l.!um

A&)#o&*ulsa&)sA&)#o&*ulsa&)s


95/98

A&)#o&*ulsa&)sA&)#o&*ulsa&)s Role & al# =)$"!a=al a#u)e a&"/o! p!o)!a#)e"Role & al# =)$"!a=al a#u)e a&"/o! p!o)!a#)e"

Role & .pola!3 esp !ap" #-#leRole & .pola!3 esp !ap" #-#le

Role & ea!l- a&)ps-#$o)# au1me&)a)o&Role & ea!l- a&)ps-#$o)# au1me&)a)o&

G!ea) fo! o&1o&1 sleep p!o.lems000 Is )$s p!o)!a#)e"G!ea) fo! o&1o&1 sleep p!o.lems000 Is )$s p!o)!a#)e"=)$"!a=al2=)$"!a=al2

Is )$e!e a !ole & #!a*&1/!elapse p!e*e&)o&2Is )$e!e a !ole & #!a*&1/!elapse p!e*e&)o&2

Is )$e!e a !ole fo! ,RN use & a1)a)e" Dual p)s3 su#$ as P m1Is )$e!e a !ole fo! ,RN use & a1)a)e" Dual p)s3 su#$ as P m1*alp!oa)e3 J m1 1a.ape&)& e)#22*alp!oa)e3 J m1 1a.ape&)& e)#22

A&)#o&*ulsa&)s & al#o$olA&)#o&*ulsa&)s & al#o$ol


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A&)#o&*ulsa&)s & al#o$olA&)#o&*ulsa&)s & al#o$ol

=)$"!a=al=)$"!a=al

Goo" e*"ee fo! #a!.ama%ep&e3 *alp!oa)e a&"Goo" e*"ee fo! #a!.ama%ep&e3 *alp!oa)e a&"

1!o=&1 fo! 1a.ape&)& a&" )op!ama)e1!o=&1 fo! 1a.ape&)& a&" )op!ama)e

Ma- e*e& .e supe!o! & )e!ms of safe)-3 a.l)-Ma- e*e& .e supe!o! & )e!ms of safe)-3 a.l)-fo! )a@e $ome "oses a&" & some s)u"es3 e*e&fo! )a@e $ome "oses a&" & some s)u"es3 e*e&

a&xe)-/a1)a)o&a&xe)-/a1)a)o&

Ha*e .ee& s$o=& e(e#)*e & $1$ "ose B,Ha*e .ee& s$o=& e(e#)*e & $1$ "ose B,"epe&"ee"epe&"ee


97/98

S)a- ool a&"S)a- ool a&"8eep alm8eep alm


98/98

ries non severe

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