Absolute Addiction Psychiatry Review An Essential Board Exam Study Guide Carla Marienfeld Editor 123 Absolute Addiction Psychiatry Review Carla Marienfeld Editor Absolute Addiction Psychiatry Review An Essential Board Exam Study Guide Editor Carla Marienfeld University of California San Diego La Jolla, CA USA ISBN 978-3-030-33403-1 ISBN 978-3-030-33404-8 (eBook) https://doi.org/10.1007/978-3-030-33404-8 © Springer Nature Switzerland AG 2020 Chapter “Laboratory Testing for Substance Use Disorders” is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) For further details see license information in the chapter This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and 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Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents Part I Introduction, Evaluation, Treatment 1 Health Services for Addiction Treatment and Levels of Care���������������� 3 Howard B Moss 2 Laboratory Testing for Substance Use Disorders ���������������������������������� 17 David Dadiomov 3 Epidemiology, Genetics, and Neurobiology of Substance Use and Disorders�������������������������������������������������������������������������������������� 31 Kristopher A Kast and Jonathan Avery 4 Screening, Evaluation, and Diagnosis of Substance Use Disorder�������� 53 Jamie Gannon, Mark Jacobson, and Katia M Harlé 5 Psychosocial Treatment of Substance Use Disorders������������������������������ 71 Natassia Gaznick and Patricia A Judd 6 Recovery from Addiction: Maintenance and Preventing Relapse�������� 87 Ricardo Restrepo-Guzman, Danielle Li, and Grace Lynn Part II Addictions and Their Treatments 7 Nicotine ������������������������������������������������������������������������������������������������������ 105 Stephanie L Hsia, Anna K Mischel, and Arthur L Brody 8 Alcohol�������������������������������������������������������������������������������������������������������� 121 Matthew E Sloan, Robert B Werner, Stephanie Yarnell-MacGrory, and Ismene Petrakis 9 Benzodiazepines and Other Sedatives, Hypnotics, and Anxiolytics ������������������������������������������������������������������������������������������ 139 Christine LaGrotta and Anil Thomas 10 Cannabinoids���������������������������������������������������������������������������������������������� 153 Joao P De Aquino and Bachaar Arnaout 11 Opioids�������������������������������������������������������������������������������������������������������� 169 Marina Tsoy-Podosenin and Anil Thomas v vi Contents 12 Stimulants: Caffeine, Cocaine, Amphetamine, and Other Stimulants�������������������������������������������������������������������������������� 185 Jeffrey J DeVido 13 Steroids, Dissociatives, Club Drugs, Inhalants, and Hallucinogens�������������������������������������������������������������������������������������� 205 Mashal Khan and Anil Thomas 14 Behavioral Addiction �������������������������������������������������������������������������������� 231 H A Colon-Rivera Part III Populations 15 Adolescents and Students�������������������������������������������������������������������������� 245 Jose Vito, Asha Martin, Ashvin Sood, and Xinlin Chen 16 Women and Pregnancy������������������������������������������������������������������������������ 259 Natasia S Courchesne and Stephanie A Meyers 17 LGBTQIA: Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual or Allied �������������������������������� 277 James Sherer and Petros Levounis 18 Underserved Populations�������������������������������������������������������������������������� 289 Theddeus Iheanacho, Ayana Jordan, and Charles Dike 19 Older Adults ���������������������������������������������������������������������������������������������� 305 Kavita Demla and Steven Huege 20 Professionals ���������������������������������������������������������������������������������������������� 319 Jonathan C Lee, P Bradley Hall, and Penelope P Ziegler Part IV Other Topics 21 Co-occurring Medical Disorders�������������������������������������������������������������� 327 Aaron Meyer 22 Co-occurring Psychiatric Disorders�������������������������������������������������������� 335 Caridad Ponce Martinez 23 Prevention, Public Health, and Public Policy������������������������������������������ 349 María Luisa Zúñiga, Sarah A Rojas, Victor Manuel Magaña, and Nafisa Ferdous 24 Ethical and Legal Considerations������������������������������������������������������������ 363 María Luisa Mittal, Leo Beletsky, and Peter J Davidson Index�������������������������������������������������������������������������������������������������������������������� 375 Contributors Bachaar Arnaout, MD Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Jonathan Avery, MD New York-Presbyterian Hospital, New York, NY, USA Weill Cornell Medical College, New York, NY, USA Leo Beletsky, JD, MPH Department of Medicine, University of California San Diego, La Jolla, CA, USA School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA Arthur L. Brody, MD Department of Psychiatry, University of California, San Diego, San Diego, CA, USA Xinlin Chen, MD MD-NYU School of Medicine, New York, NY, USA H. A. Colon-Rivera, MD Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Department of Behavioral Health, Asociación Puertorriquos en Marcha, Inc (APM), Philadelphia, PA, USA Natasia S. Courchesne, MPH Department of Psychiatry, University of California, San Diego, San Diego, CA, USA David Dadiomov, PharmD, BCPP University of Southern California School of Pharmacy, Los Angeles, CA, USA Peter J. Davidson, PhD Department of Medicine, University of California San Diego, La Jolla, CA, USA Joao P. De Aquino, MD Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Kavita Demla, MD University of California San Diego, La Jolla, CA, USA Jeffrey J. DeVido, MD, MTS Behavioral Health and Recovery Services; Marin County California Department of Health and Human Services, San Rafael, CA, USA vii viii Contributors Partnership HealthPlan of California, Fairfield, CA, USA University of California, San Francisco, Department of Psychiatry, San Francisco, CA, USA Charles Dike, FRCPsych, MBChB, MPH Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Nafisa Ferdous, MH San Diego State University, School of Social Work, Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA University of California, San Diego and San Diego State University, San Diego, CA, USA Jamie Gannon, PhD Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Natassia Gaznick, MD, PhD Department of Psychiatry, University of California, San Diego, San Diego, CA, USA P. Bradley Hall, MD, DABAM, DFASAM Federation of State Physician Health Programs, Mount Clare, WV, USA Katia M. Harlé, PhD Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA VA San Diego Health System, La Jolla, CA, USA Stephanie L. Hsia, PharmD, BCPS, BCPP Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA Steven Huege, MD University of California San Diego, La Jolla, CA, USA Theddeus Iheanacho, MD Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Mark Jacobson, PhD Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA Ayana Jordan, MD, PhD Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA Patricia A. Judd, PhD Department of Psychiatry, University of California, San Diego, San Diego, CA, USA Kristopher A. Kast, MD New York-Presbyterian Hospital, New York, NY, USA Weill Cornell Medical College, New York, NY, USA Mashal Khan, MD Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY, USA Contributors ix Christine LaGrotta, MD Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY, USA Jonathan C. Lee, MD The Farley Center at Williamsburg Place, Williamsburg, VA, USA Petros Levounis, MD, MA Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ, USA Danielle Li, MD Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA Grace Lynn, MD Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA Victor Manuel Magaña, MA San Diego State University, School of Social Work, Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA University of California, San Diego and San Diego State University, San Diego, CA, USA Asha Martin, MD MD-NYU School of Medicine, New York, NY, USA Caridad Ponce Martinez, MD Department of Psychiatry, of Massachusetts School of Medicine, Worcester, MA, USA University Aaron Meyer, MD Department of Psychiatry, University of California, San Diego, San Diego, CA, USA Stephanie A. Meyers, MA Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA Anna K. Mischel, BA Veterans Medical Research Foundation, VA San Diego Healthcare System, San Diego, CA, USA María Luisa Mittal, MD Department of Medicine, University of California San Diego, La Jolla, CA, USA Howard B. Moss, MD Department of Psychiatry and Neuroscience, University of California at Riverside School of Medicine, Riverside, CA, USA Ismene Petrakis, MD Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA VA Connecticut Healthcare System #116-A, West Haven, CT, USA Ricardo Restrepo-Guzman, MD, MPH Department of Psychiatry and Human Behavior, University of California, Irvine, Long Beach, CA, USA Sarah A. Rojas, MD Family Health Centers San Diego, San Diego, CA, USA x Contributors James Sherer, MD Rutgers New Jersey Medical School, Newark, NJ, USA Matthew E. Sloan, MD, MSc Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA Ashvin Sood, MD MD-NYU School of Medicine, New York, NY, USA Anil Thomas, MD Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY, USA Marina Tsoy-Podosenin, MD, PhD Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY, USA Jose Vito, MD MD-NYU School of Medicine, New York, NY, USA Robert B. Werner, MD Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA Stephanie Yarnell-MacGrory, MD, PhD Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA Penelope P. Ziegler, MD Emerita Florida Professionals Resource Network, Fernandina Beach, FL, USA María Luisa Zúđiga, PhD San Diego State University, School of Social Work, Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA 24 Ethical and Legal Considerations 371 C Title 42 of the Code of Federal Regulations Part D Law 30/2000 Correct answer: A. The expansion of naloxone access has directly reduced opioid overdoses by increasing the availability of an overdose reversal drug in the community Rockefeller Drug Laws raised criminal penalties for the sale and possession of drugs, primarily heroin Part is a distracting answer, and is related to privacy laws Law 30/2000 has helped reduce opioid overdoses in Portugal A 39-year-old male with 5 years of methadone maintenance treatment recently lost insurance coverage If a substance use treatment program is subject to both 42 CFR Part and HIPPA Privacy Rule, can they disclose a medical record number to obtain authorization for referring an individual to another healthcare provider? A Yes, the medical record number can be used to identify the patient by sources external to the program B Yes, even though the medical record number can identify the patient, it is important to not delay the referral while waiting for patient consent C No, a medical record number is considered protected health information D No, one must contact legal counsel for assistance before reaching a decision Correct answer: C. Under the Privacy Rule, a program may not use or disclose protected health information, which includes information that may identify a patient such as the medical record number The other options are distracting answers References Beauchamp TL, Childress JF. Principles of biomedical ethics 7th ed New York: Oxford University Press; 2012 Dickens BM, Cook RJ. Law and ethics in conflict over confidentiality? Int J Gynecol Obstet 2000;70(3):385–91 D’Aunno T, Park S, Pollack HA. 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Br J Criminol 2010;50(6):999–1022 19 National Institute of Law Enforcement and Criminal Justice The Nation’s toughest drug law: evaluating the New York experience – final report of the Joint Committee on New York Drug Law Evaluation New York: The Association of the Bar of the City of New York; 1978 20 Kaeble D, Cowhig M. Correctional populations in the United States, 2016 U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics 2018; NCJ 251211:1–13 [cited 2019 May 10] Available from: https://www.bjs.gov/content/pub/pdf/cpus16.pdf 21 Kaiser Family Foundation Status of state action on the medicaid expansion decision [Internet] KFF State Health Facts 2018 [cited 2019 May 10] Available from: https://www.kff.org/ health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordablecare-act 22 Fiscella K, Beletsky L, Wakeman SE. The inmate exception and reform of correctional health care Am J Public Health 2017;107(3):384 23 Gostin LO, Hodge JG, Noe SA. Reframing the opioid epidemic as a national emergency JAMA 2017;318(16):1539–40 24 Network for Public Health Law Legal interventions to reduce overdose mortality: naloxone access and overdose good Samaritan Laws Network for Public Health Law (USA); 2018 [cited May 10, 2019] Available from: https://www.networkforphl.org/_asset/qz5pvn/legalinterventions-to-reduce-overdose.pdf 25 Harrison Narcotics Tax Act Public law # 63–223 1914 26 Webb v United States, 249 U.S 96, 39 S. Ct 217, 63 L. Ed 497 1919 27 Linder v United States, 268 U.S 5, 45 S. Ct 446, 69 L. Ed 819 1925 28 U.S. Food and Drug Administration Methadone oral concentrate (methadone hydrochloride oral concentrate USP) and methadone sugar- free oral concentrate (methadone hydrochloride oral concentrate USP) dye-free, sugar-free, unflavored [cited 2019 May 10] Available from http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017116s021lbl.pdf 29 Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction Proposed modification of dispensing restrictions for buprenorphine and buprenorphine combination as used in approved opioid treatment medications 42 C.F.R § 8.12 (2016) [regulation on the Internet] [cited 2019 May 10] Available from: https://www.ecfr.gov/cgi-bin/retrieveECFR? gp=&SID=e3d2eafa3a0991f90e93a038912a687e&mc=true&n=pt42.1.8&r=PART&ty=HTM L#sp42.1.8.c 24 Ethical and Legal Considerations 373 30 U.S. Department of Health and Human Services Qualify for a practitioner waiver [Internet] Substance Abuse and Mental Health Services Administration 2019 Available from: https:// www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/ qualify-for-practitioner-waiver 31 CSAT (Center for Substance Abuse Treatment) The confidentiality of alcohol and drug abuse patient records regulation and the HIPAA privacy rule: implications for alcohol and substance abuse programs DHHS publication no (SMA) 04-3947 Substance Abuse and Mental Health Services Administration: Rockville; 2004 https://www.integration.samhsa.gov/operationsadministration/the_confidentiality_of_alcohol_and_drug_abuse.pdf Index A Acamprosate, 131 Acceptance and commitment therapy, 347 Acute inhalant intoxication, 213 Addiction psychiatrists, 351 Addiction Severity Index (ASI), Adenosine A1 receptor upregulation, 188 Adolescent community reinforcement approach (A-CRA), 252 Adolescent psychiatric disorders, 161–162 Adolescents and students substance use co-occurring psychiatric conditions ADHD, 250 anxiety, 251 conduct disorder, 250 major depressive and bipolar disorder, 250–251 PTSD, 251 epidemiology, 246–247 neurobiological considerations, 247 protective factors environmental and societal considerations, 248–250 psychological and developmental considerations, 247–248 risk factors, 251 environmental and societal considerations, 248–250 psychological and developmental considerations, 247–248 screening, 252 treatment considerations alcohol, 253 behavioral approaches, 252, 253 benzodiazepines, 254 consent, confidentiality, and decision making, 252 pharmacotherapy approaches, 253 tobacco, 253–254 Affordable Care Act (ACA), 7, 339, 370 Alcohol-associated cognitive disorders, 312, 313 Alcoholic hallucinosis, 126 Alcoholics Anonymous, 342 Alcohol intoxication (AI), 124, 125 Alcohol-related dementia (ARD), 312 AlcoholScreening.org, 54 Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), 56 Alcohol use disorder (AUD), 290 alcohol intoxication, 124, 125 alcohol withdrawal, 126 delirium tremens, 126, 127 hallucinosis, 126 management, 126, 127 symptoms, 126 withdrawal seizures, 126, 127 diagnosis, 129 direct biomarkers, 128 epidemiology, 122 FDA-approved pharmacotherapies acamprosate, 131 disulfiram, 129 naltrexone, 131 genetics, 122–123 indirect biomarkers, 128 non-FDA approved pharmacotherapies, 131, 133 pharmacodynamics, 124 pharmacokinetics, 123–124 screening, 129 Alcohol Use Disorders Identification Test (AUDIT), 56, 264, 310 Alcohol withdrawal, 126 delirium tremens, 126, 127 hallucinosis, 126 management, 126, 127 symptoms, 126 withdrawal seizures, 126, 127 © Springer Nature Switzerland AG 2020 C Marienfeld (ed.), Absolute Addiction Psychiatry Review, https://doi.org/10.1007/978-3-030-33404-8 375 376 α-amino-3-hydroxy-5-methylisoxazole-4- propionic acid (AMPA) receptors, 124 American Society for Addiction Medicine (ASAM) Patient Placement Criteria, Amphetamine and amphetamine-type (AAT) stimulants α-methylphenethylamine (amphetamine), 195, 196 behavioral/psychosocial therapies, 197 catecholaminergic neurons, 196 diverse array of compounds, 194 d-methamphetamine, 196 ephedrine-containing Ephedra plants, 195 immunoassays, 196 manualized Matrix Model, 197 methamphetamine, 195, 196 transporter substrates, 196 vasoconstrictive effects, 196 Amphetamine immunoassays, 29 Anabolic-androgenic steroids (AAS) anabolic steroids and sources, 206–207 assessment and management, 209–210 cardiovascular, 208 endocrine, 208 epidemiology, 206 hepatic, 208 musculoskeletal, 208 neuro-psychiatric/behavioral, 208 patterns of use, 207 pharmacodynamics, 207 presentation and adverse medical effects, 207–209 skin, 208 Antenatal Psychosocial Health Assessment (ALPHA) tool, 265 Anxiety, 161, 251, 340, 341 Atrophy, 313 Attention deficit/hyperactivity disorder (ADHD), 162, 250, 342 Attorneys, 320 Atypical antipsychotics, 341 AUDIT-C, 271 B Baby Boomer generation, 307 Baclofen, 133 Barbiturates adverse effects, 145 clinical uses, 145 mechanism of action, 145 treatment, 146 Bath salts, 27, 28 Index Behavioral addiction, 235 compulsive buying/shopping addiction, 232 defining components, 231 dysfunction of, 232 eating addictions, 233–234 gambling disorder, 232 neurobiology and genetics, 234 pharmacologic treatments glutamate, 236 N-acetylcysteine, 236 N-methyl-D-aspartate glutamate receptor, 236 opiate antagonists, 236 psychosocial treatments, 234 craving behavioral intervention, 236 group psychotherapy, 235 repetitive maladaptive engagement, 232 sex addiction, hypersexual behaviors, 232–233 video games and internet addiction, 234 Behavioral couples therapy, 80 Behavioral theory, 82 Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS), 341–342 Benzodiazepines, 24, 25, 328, 329 adverse effects, 147 diagnosis, 142 epidemiology, 140 intoxication clinical syndrome, 142 laboratory/diagnostic evaluation, 143 overdose, 142, 143 treatment, 143 mechanism of action, 140, 141 pharmacokinetics, 141 pharmacology, 146, 147 risk factors, 140 withdrawal clinical syndrome, 144 treatment, 144 Biological sex, 279 Biomedical ethics beneficence, 364 justice, 364, 365, 369 non-maleficence, 364, 365 respect for autonomy, 364 Blood alcohol content (BAC) expression, 23 Body dysmorphic disorder, 206 Brief interventions, 264 Brief psychotherapeutic interventions, 266 Brief strategic family therapy (BSFT), 79 Buprenorphine, 22, 178 Bupropion SR (Zyban®), 113 Index C Caffeine, 330 abrupt discontinuation or marked reduction, 188 adenosine A1 receptor upregulation, 188 atypical antipsychotic clozapine and lithium toxicity, 189 caffeine’s psychomotor-reinforcing effects, 188 deleterious health consequences, 187 endogenous adenosine activity, 188 facilitating hair growth, 187 half-life, 189 hyperarousal, 188 ingestion, 188 intoxication, 188 manualized cognitive behavioral therapy, 188 maternal caffeine consumption during pregnancy, 189 tobacco cigarette smokers and alcohol- dependent, 188 ubiquity and relative minor health or psychological impact, 188 Caffeine’s psychomotor-reinforcing effects, 188 Calcium-dependent-signaling genes, 39 Cannabinoids acute intoxication, 158 adolescent psychiatric disorders, 161–162 anxiety disorders, 161 attention-deficit/hyperactivity disorder, 162 available cannabis products, 157–158 behavioral effects attention, 159 cognitive effects, 159 inhibitory control, 159 memory, 159 mood/anxiety, 158 psychosis, 158 cannabis withdrawal syndrome, 161 cognitive effects, 160 epidemiology, 154 medical and recreational cannabinoid use policy, 154 mood disorders, 162 motoric effects and relevance, 159 pharmacology endocannabinoid (eCB) system, 155 plant-based cannabinoids, 156 synthetic cannabinoids, 156 posttraumatic stress disorder, 162 psychotic disorders, 161 sleep disorder, 162 Cannabis, 45, 46, 307, 308, 330 377 Cannabis Problems Questionnaire, 163 Cannabis use disorder (CUD) gateway hypothesis, 160 genetic factors, 164 lifetime rates, 160 medical use, 164 neurocircuitry, 160 pharmaceutical interactions, 164, 165 pharmacological interventions, 163 psychosocial treatments, 163 screening tools, 163 Cannabis Use Problems Identification Test (CUPIT), 163 Cannabis withdrawal syndrome (CWS), 161 Carbohydrate deficient transferrin (CDT), 23, 128, 328 Cardiovascular deficits, 328 Case and care management models, 314 Child Protective Services (CPS), 263 Clinical case management programs, 292 Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar), 127 Clinically managed low-intensity residential program, 10 Clinically managed population-specific high-intensity residential programs, 11 Clinically managed residential programs, 11 Clinical Opioid Withdrawal Scale (COWS), 175 Closing gender gap, 35 Club drugs assessment and management, 223 3,4-methylenedioxy-methamphetamine, 222 Cocaine, 26 acute and chronic movement disorders, 193 behavioral and physical criteria, 193 behavioral therapies, 194 binge, 193 erythroxylum (coca) bush endemic, 191 freebase, 192 ingestion, 193 medical and psychiatric sequelae, 193 mesocorticolimbic pathway, 192 mindfulness-based treatments, 194 novel cocaine vaccines, 194 onset of effect, 192 psychomotor and reinforcing effects, 192 psychosocial/behavioral treatments, 194 reuptake blocker, 192 salt and base, 192 vaporization point and “burning” point, 192 vaporized cocaine, 193 Index 378 Code of Federal Regulations (CFR), 368 Cognitive behavioral therapy (CBT), 72, 94–96, 116, 234, 252, 266 Community reinforcement and family training (CRAFT), 81 Community reinforcement approach (CRA), 266 Comorbidity-Alcohol Risk Evaluation Tool (CARET), 310 Compulsive buying/shopping addiction, 232 Conditioned positive reinforcement, 99 Conduct disorder, 250 Construct validity, 58 Content validity, 58 Contingency management (CM), 74, 75, 83, 164, 198, 266, 322 Continuum of care, 5, 15 Controlled Substances Act, 368 Co-occurring medical disorders alcohol, 328 benzodiazepine, 328, 329 caffeine, 330 cannabis, 330 opioids, 329 PCP, hallucinogens, inhalants, 330 stimulants, 329 tobacco use, 330 Co-occurring psychiatric disorders assessment and diagnosis, 337, 338 epidemiology ECA study, 336, 337 National Comorbidity Survey, 336, 337 outcomes, 343, 344 treatment anxiety disorders, 340, 341 attention-deficit and hyperactivity disorder, 342 eating disorders, 343 mood disorders, 339, 340 personality disorders, 343 pharmacologic and psychosocial interventions, 339 psychiatric and substance use treatments, 339 psychotic disorders, 341, 342 trauma-related disorders, 342 Corticosteroids, 48 Counseling groups, 97 CRAFFT questionnaire, 265 Craving behavioral intervention, 236 Criminal justice system (CJS), 296 jails, 297 post incarceration treatment, 297, 298 pre-incarceration interventions, 296, 297 SUD, 296 Crystal methamphetamine, 283 D Delirium tremens, 126, 127 Dementia, 312 Dextromethorphan (D-3-methoxy-Nmethylmorphinan, DM, DXM), 220, 221 Dissociative anesthetics assessment and management, 221–222 dextromethorphan, 220, 221 ketamine, 220 pharmacologic features, 219 phencyclidine, 219 Dissociative drugs, 27 Disulfiram, 129 Dopamine, 44 Dopamine D2 receptor (DRD2), 39 Driving under the influence (DUI), 61 Dronabinol, 164 Drug Abuse Screening Test (DAST), 56, 264 Drug Addiction Treatment Act, 368, 370 Drug Treatment Alternative to Prison (DTATP), 297 Dual recovery therapy, 341, 346 E Eating addiction, 233–234 Eating disorders, 343 Electronic cigarettes, 114, 115, 117 Emotional relapse, 93 Endocannabinoid (eCB) system, 155 Endogenous opioid system, 171 Epidemiologic Catchment Area (ECA) study, 336, 337, 345 Epigenetic mechanisms, 40 Eszopiclone, 147 Ethical and legal considerations addictions and law, 366–367 biomedical ethics beneficence, 364 justice, 364, 365, 369 non-maleficence, 364, 365 respect for autonomy, 364 discrimination, 365, 366 medical licensure and credentialing, 367, 368 naloxone access, 371 privacy laws, 368, 369 status loss and discrimination, 370 stigma, 366 Index Exogenous opioids, 171 External triggers, 96, 99 F Family therapy, 79 Fatty acid amide hydrolase (FAAH), 155 Federal Aviation Administration (FAA), 320 Federal urine drug screening cutoffs, 19 Functional family therapy (FFT), 80 G Gabapentin, 131 Gambling disorder (GD), 232, 239 Gambling Symptom Assessment Scale (GSAS), 232 Gamma-aminobutyric acid (GABA), 124 Gamma glutamyl transferase (GGT), 23, 28 Gamma-hydroxybutyric acid (GHB), 223, 224, 283, 284 Gamma-hydroxy-methamphetamine (GHB), 285 Gay men alcohol use disorders, 283 crystal methamphetamine, 283 ecstasy, 283 gamma-hydroxy-butyrate, 283, 284 prevalence, 283 Gender, 278 Gender expression, 278 Gender identity, 278 Gender responsive treatments (GRTs), 265 Generalized anxiety disorder (GAD), 340, 341 Generalized tonic-clonic seizures, 190 Glutamate, 236 Glutamate receptors, 124 Group psychotherapy, 235 H Hallucinogens, 27 assessment and management, 218 clinical features, 215, 217 DMT, 216 epidemiology, 214–215 LSD, 215 mescaline (3,4,5trimethoxyphenethylamine), 216 organic sources, 214 pharmacologic features, 214 phenylethylamines, 214 psilocybin, 215 salvia, 217 379 tryptamines, 214 Harm reduction & gender responsive treatment, 265–266 Harrison Narcotics Tax Act, 367, 370 Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, 368, 369 Health promotion, 354, 355 Health services in addiction treatment, adolescent treatment, 12 alcohol withdrawal symptoms, 14 ASAM/Medicaid adult levels of care, clinically managed low-intensity residential program, 10 clinically managed population-specific high-intensity residential programs, 11 clinically managed residential programs, 11 early intervention, intensive outpatient programs, 10 medically managed intensive inpatient programs, 12 medically monitored inpatient programs, 11 opioid treatment services, outpatient services, partial hospitalization programs, 10 continuum of care, 15 current best practices treatment models addiction, 4, continuum of care, integrated healthcare delivery systems, managed care, medicaid, medicare, patient engagement and retention, systematic multidimensional clinical assessment, definition, intake evaluation, 14 quality performance measures, 12–13 standardized levels of care, tobacco use disorders, 14 Heaviness of Smoking Index (HSI), 109 Hepatic dysfunction, 328 Heroin, 27, 171 Homeostatic anti-reward system, 43 Homeostatic urinalysis ranges, 20, 21 5-HTTLPR short allele, 48 Human Intervention Motivation Study (HIMS) programs, 322 380 I Illicit drug use disorder, 32 Immunoassays, 18 Incremental validity, 58 Informed consent, 365 Inhalants assessment, 213 epidemiology, 211 management, 213 methods, 211 nitrites, 213 nitrous oxide, 213 onset of symptom, 211 pharmacodynamics, 211–212 pharmacokinetics, 211–212 sudden sniffing death, 212 toxic effects, 212 types, 210 volatile hydrocarbons, 212 Integrated group therapy, 347 Integrated healthcare delivery systems, Integrated health models, 295 Intensive outpatient programs, 10, 197 Internal triggers, 96, 99 Inter-rater reliability, 57 K Kainate receptors, 124 Ketamine, 220, 283 Kinsey scale, 279 L Laboratory drug testing advantages and disadvantages, 19, 20 alcohol, 23 benzodiazepines, 24, 25 breath testing, 19 conducting hair and nail testing, 19 dissociative drugs, 27 false positive and negative test, 19, 20 federal urine drug screening cutoffs, 19 hallucinogens, 27 homeostatic urinalysis ranges, 20, 21 marijuana, 25 opioids, 21 principles, 18 screening tools, 18 standard 5-panel drug test, 19 stimulants, 26 synthetic cannabinoids, 25, 26 Lawyer assistance programs (LAPs), 320 Leptin, 233 Index Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual or allied (LGBTQIA), 277, 278 curiosity and acceptance flows, 281 epidemiology, 282 heteronormative providers, 279 Lesbians, 284 Level of Care Utilization System (LOCUS), Liver function tests (LFTs), 23 Lysergic acid diethylamide (LSD), 214, 285 M Major depressive disorder, 344 Managed care, Manualized Matrix Model, 197 Marijuana, 25 MAST-G, 310 Maternal Opioid Treatment: Human Experimental Research (MOTHER) trial, 268 Matrix model, 80 Medicaid, 7, Medical and recreational cannabinoid use policy, 154 Medically managed intensive inpatient programs, 12 Medically monitored inpatient programs, 11 Medicare, Medications for addiction treatment (MAT), 292 Mental health concerns, 319 Mental Health Parity and Addiction Equity Act (MHPAEA), 7, 339 Mental relapse, 93 Mescaline (3,4,5- trimethoxyphenethylamine), 216 Methadone, 22, 177 Methadone’s metabolite 2-ehtylidene-1,5- dimethyl-3,3-diphenylpyrollidine (EDDP), 22 Methamphetamine-induced psychotic disorder, 191 3,4-Methylenedioxy-methamphetamine (MDMA), 222, 283 Michigan Alcoholism Screening Test (MAST), 56 Milieu groups, 97 Mindfulness-based relapse prevention (MBRP), 75 Mindfulness based stress reduction, 346 Mindfulness-based therapies (MBT), 75, 76 Mindfulness-oriented recovery enhancement (MORE), 76, 82 Index Mobile crisis teams (MCTs), 296 Mobile medication units (MMUs), 292 Modified cognitive behavioral therapy, 341 Modified motivational enhancement therapy, 341 Monitoring the Future (MTF) survey, 154 Monoacylgycerol lipase (MAGL), 155 Monoamines, 44 Mood disorders, 162, 270, 339, 340, 347 Motivational enhancement therapy (MET), 73, 74, 83, 164, 314 Motivational interviewing (MI) techniques, 73, 110, 264, 314 Motivation-based therapies, 73, 74 Multidimensional family therapy (MDFT), 79–80, 250 Multifamily educational intervention (MEI), 253 Multi-method assessment approach, 57 Multisystemic therapy (MST), 79, 250 Mutual aid groups, 77–79 N N-acetylcysteine (NAC), 236 Naltrexone, 131 Narcotic Addict Treatment Act, 368, 370 Narcotics, 170 Narrow therapeutic index, 146 National Comorbidity Survey (NCS), 336, 337 National Comorbidity Survey Replication (NCSR), 290, 345 National Epidemiological Survey on Alcohol and Related Conditions (NESARC), 290, 345 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 122 National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) Question Screen, 55 National Longitudinal Alcohol Epidemiologic Survey (NLAES), 336, 345 National Survey on Drug Use and Health (NSDUH), 290 Neurobiological model binge/intoxication stage and striatum, 42 craving stage, 44 extended amygdala, 43, 44 neurodevelopment in adolescence, 44 prefrontal cortex, 44 relevant neurotransmitter systems, 44–45 withdrawal/negative affect stage, 43 Neurochemical process, 92 Nicotine, 26 381 consequences of use, 106 electronic cigarettes, 114, 115, 117 epidemiology, 106 pathogenesis intoxication, 107–108 withdrawal symptoms, 108 pharmacodynamics, 107 pharmacokinetics, 106–107 tobacco use disorder assessment, 109 diagnostic criteria, 108 non-pharmacological treatment, 110 pharmacological treatment, 110–114, 117 Nicotine replacement therapy (NRT), 111 Nitrites, 213 Nitrous oxide, 213 N-methyl-D-aspartate (NMDA) glutamate receptor, 124, 236 Nociceptive receptors, 171 Nonbenzodiazepine sleeping agents, 146 Norbuprenorphine, 22 Norepinephrine, 45 Normative feedback, 314 Nucleus accumbens, 237 O Office-based opioid treatment (OBOT), Older adults aging and medical and functional complications, 310–312 alcohol-associated cognitive disorders, 312, 313 at-risk substance use, 309 AUDIT, 310 “Baby Boom” generation, 305–307 biologic and social factors, 308 CAGE questionnaire, 309 CARET, 310 diagnosis, 308, 309 in geriatric population, 306, 309–311, 313 MAST-G, 309, 310 prevalence rates alcohol, 306, 307 illicit drugs, 307 prescription, nonprescription, and OTC medication use, 308 treatment considerations, 313, 314 Opioid agonist, 177, 178, 180–181 Opioid antagonists, 178–181 Opioid intoxication, 173 Opioid overdose, 173 Opioid system, 45 382 Opioid treatment programs (OTPs), 9, 368 Opioid use disorder (OUD), 290 diagnosis, 171–172 epidemiology, 171 generic , trade , and street name, 170 laboratory tests, 173 maintenance treatment opioid agonist, 177, 178, 180–181 opioid antagonists, 178–181 pregnant women, 179, 182 opioid intoxication, 173 opioid overdose, 173 opioid withdrawal benzodiazepines, 176 buprenorphine, 175, 176 clonidine, 176 diagnostic criteria, 174 half-life of drug, 174 intermittent drug use, 174 management, 175 methadone, 175 protracted abstinence syndrome, 174 severity of, 174 pharmacology, 171 physical examination, 172 Opioid withdrawal benzodiazepines, 176 buprenorphine, 175, 176 clonidine, 176 diagnostic criteria, 174 half-life of drug, 174 intermittent drug use, 174 management, 175 methadone, 175 protracted abstinence syndrome, 174 severity of, 174 P Panic disorder, 340 Paranoid delusions, 190 Partial hospitalization programs, 10 Party drugs, 283 Peroxisome proliferator activated receptors (PPAR’s), 156 Personality Assessment Inventory (PAI), 59 Personality disorders, 343 Pharmacodynamics, 107 Pharmacokinetics, 106–107 Phencyclidine (PCP), 219 Phenylethylamines, 214 Physical relapse, 94 Physician health programs (PHPs), 319, 320, 322 Index Plant-based cannabinoids, 156 Policy enforcement, 354, 355 Post incarceration treatment, 297, 298 Posttraumatic stress disorder (PTSD), 162 Prefrontal (top-down) cognitive control system, 49 Prefrontal glutamatergic projections, 44 Pregnant women barriers to care, 263 CRAFFT questionnaire, 265 epidemiology, 261 harm reduction & gender responsive treatment, 265–266 legal consequences, 262–263 physiological consequences, 261–262 screening and evaluation, 264 screening instruments, 265 social consequences, 262, 263 structured self-report instruments, 264 substance use and breastfeeding, 269 treatment alcohol, 266 cannabis, 267 opioids, 268, 269 stimulants, 267 tobacco, 267 Pre-incarceration interventions, 296, 297 Prescription drug monitoring programs (PDMPs), 90, 354 Prevention harm reduction, 353 primary, 350, 352, 353 secondary, 350, 352, 353 tertiary, 350, 353 Privacy Rule, 371 Prodrug lisdexamfetamine dimesylate (Vyvanse), 234 Profession-specific support groups, 321 Protracted abstinence syndrome, 174 Psilocybin, 215 Psychiatric comorbidity, 58 Psychodynamic therapy, 76, 77, 84 Psychoeducational recovery groups, 97 Psychosis, 158 Psychotherapeutic treatment cognitive behavioral therapy, 72 contingency management, 74, 75 mindfulness-based therapies, 75, 76 motivation-based therapies, 73, 74 mutual aid groups, 77–79 psychodynamic therapy, 76, 77, 84 systems-based therapy behavioral couples therapy, 80 family therapy, 79 Index matrix model, 80 Psychotherapy, 110 Psychotic disorders, 161, 341, 342 Public health, 351 community mobilization and engagement, 354, 355 definition, 350 disease prevention strategies and activities, 354, 355 health promotion, 354, 355 identify and investigate health problems, 354, 355 infrastructure, 354, 356 linking the public to health services, 354, 355 local, regional, national and global scales, 350 policy development, 354 policy enforcement, 354, 355 public health infrastructure, 354, 356 research, 354, 356 social determinants of health, 350 surveillance, 354, 355 Public policy, 351 R Recovery action stage, 89, 98 behavioral changes, 92–93 biopsychosocial vulnerabilities lead to SUD, 92 cognitive behavioral framework, 94–96 contemplation stage, 89 coping skill groups, 97 definition, 88 drug cravings, 99 early recovery prescription drug monitoring programs, 90 toxicology, 90–91 external triggers, 96 internal triggers, 96 maintenance and relapse prevention, 89 measurement, 91 pathways, 90 precontemplation stage, 88, 98 preparation stage, 89, 98 relapse and relapse prevention emotional relapse, 93 mental relapse, 93 physical relapse, 94 relapse stage, 98 Reinforcement-based therapy (RBT), 267 383 S Safety-sensitive occupations, 320 Safety-sensitive professionals’ work environment, 321 Safety-sensitive workers, 320 airline pilots, 322 cognitive abilities, 322 complex drug screening, 322 contingency management, 322 dynamic defenses and coping mechanisms, 321 identification and assessment, 320 medications, 322 monitoring entities, 322 profession-specific group therapy, 321 treatment, 321, 322 work environment, 322 Sahker’s analysis, 313 Salvia, 217 Screening brief intervention and referral to treatment (SBIRT), 264, 271, 352 Second wave therapy, 72 Seeking Safety, 346 Serotonin, 45 Severity of Dependence Scale (SDS), 163 Sexual history, 281 Sexual identity, 279 Sexual orientation, 278, 279 Sleep disorder, 162 SMART Recovery® (Self-Management and Recovery Training), 78 Smoking, 116 Social anxiety disorder, 340 Social determinants of health (SDOH), 294, 295, 350 Sodium oxybate, see Gamma-hydroxybutyric acid Specialized groups, 97 Standard 5-panel drug test, 19 Stevens-Johnson syndrome, 149 Stigma, 366 Stimulants, 26, 329 AAT stimulants α-methylphenethylamine (amphetamine), 195 amphetamine, 195, 196 behavioral/psychosocial therapies, 197 catecholaminergic neurons, 196 diverse array of compounds, 194 d-methamphetamine, 196 ephedrine-containing Ephedra plants, 195 immunoassays, 196 manualized Matrix Model, 197 384 Stimulants (cont.) methamphetamine, 195, 196 transporter substrates, 196 vasoconstrictive effects, 196 behavioral interventions, 190 caffeine abrupt discontinuation or marked reduction, 188 adenosine A1 receptor upregulation, 188 atypical antipsychotic clozapine and lithium toxicity, 189 caffeine’s psychomotor-reinforcing effects, 188 deleterious health consequences, 187 endogenous adenosine activity, 188 facilitating hair growth, 187 half-life, 189 hyperarousal, 188 ingestion, 188 intoxication, 188 manualized cognitive behavioral therapy, 188 maternal caffeine consumption during pregnancy, 189 tobacco cigarette smokers and alcohol-dependent, 188 ubiquity and relative minor health or psychological impact, 188 central and peripheral nervous systems, 186 cocaine acute and chronic movement disorders, 193 behavioral and physical criteria, 193 behavioral therapies, 194 binge, 193 erythroxylum (coca) bush endemic, 191 ingestion, 193 medical and psychiatric sequelae, 193 mesocorticolimbic pathway, 192 mindfulness-based treatments, 194 novel cocaine vaccines, 194 onset of effect, 192 psychomotor and reinforcing effects, 192 psychosocial/behavioral treatments, 194 reuptake blocker, 192 salt and base, 192 twelve-step fellowships, 194 vaporization and burning point, 192 vaporized cocaine, 193 cognitive performance, 186 contingency management, 198 generalized tonic-clonic seizures, 190 high potency antipsychotics, 191 Index intoxication, 186, 189, 190 medical uses, 186 naturally occurring stimulants, 186 negative physiologic effects, 187 non-caffeine/tobacco stimulants, 189 paranoid delusions, 190 patient self-report, 191 physical restraints, 190 physiological and psychiatric effects, 186 prolonged use, 191 psychosis, 190 synthetic stimulants, 186 unspecified stimulant related disorders, 186 use disorders, 186 visual/somatosensory hallucinations, 190 withdrawal syndrome, 186, 191 Subjective Opiate Withdrawal Scale (SOWS), 175 Substance Abuse Management Module, 341 Substance use disorder (SUD), 239, 290 cannabis, 45, 46 CYP2B6, 41 CYP2D6, 41 epidemiology, 32–34 alcohol, 33 closing gender gap, 35 comorbidity, 36, 37 consequences of use, 37, 38 culture, race, ethnicity, immigration, 36 opioids, 33 tobacco, 33 transition, 35 treatment gap, 36 trends, 33 unhealthy substance use, 33 epigenetic mechanisms, 40 evaluation and diagnosis at-risk, 60 comprehensive psychiatric history, 65 family history, 65 history of presenting illness, 62 medical history, 65 psychiatric/mental status exam, 66 social/developmental history, 65 substance use and treatment history, 63 gender gap, 46 genetics gene-by-environment interaction, 40 genes implicated in addiction-related neurocircuits, 39 genes implicated in substance metabolism, 38 genetic risk, 38 with unknown SUD-related function, 39 Index inter-rater reliability, 57 naltrexone, 41 neurobiological model binge/intoxication stage and striatum, 42 craving stage, 44 extended amygdala, 43, 44 neurodevelopment in adolescence, 44 prefrontal cortex, 44 relevant neurotransmitter systems, 44–45 withdrawal/negative affect stage, 43 psychometric assessment MCMI3/4, 59 MMPI2/MMPI2RF, 59 PAI, 59 psychometric tests and interviews, 57 reliability, 57 screening tests AlcoholScreening.org, 54 ASSIST, 56 AUDIT, 56 CAGE questionnaire, 54 CRAFFT screening, 55 Drug Abuse Screening Test, 56 Michigan Alcoholism Screening Test, 56 NIAAA Question Screen, 55 sociodemographic variables, 57 WIPHL, 56 test-retest reliability, 57 validity, 58 Sudden sniffing death, 212 Supportive therapy models, 314 Synthetic cannabinoids (SC), 25, 26, 156 Synthetic stimulants, 186 Systematic multidimensional clinical assessment, Systems-based therapy behavioral couples therapy, 80 community reinforcement and family training, 81 family therapy, 79 matrix model, 80 T T-ACE, 271 Telescoping, 122 Test-retest reliability, 57 Thiamine deficiency, 328 Tobacco dependence, 106 Tobacco use disorder (TUD) assessment, 109 385 diagnostic criteria, 108 non-pharmacological treatment, 110 pharmacological treatment, 110 bupropion SR (Zyban®), 113 clonidine, 114 combination NRT, 111–113, 117 nicotine replacement therapy, 111 nortriptyline, 114 Varenicline (Chantix®), 113, 114 Topiramate, 131 Transporter substrates, 196 Transtheoretical model of change (TTM), 88, 89 Trauma-related disorders, 342 Tryptamines, 214 TWEAK, 271 Twelve-step groups, 77 U Underserved populations criminal justice system federal and state prisons, 297 jails, 297 post incarceration treatment, 297, 298 pre-incarceration interventions, 296, 297 faith-based, 295 homelessness, 289, 290 alcohol use disorder, 290 barriers to treatment, 291–292 co-morbidities and mortality, 291 epidemiological surveys, 290 mobile medication units, 292 mobile treatment units, 292 opioid agonist treatment, 292 opioid use disorder, 290 service frameworks and available resources, 292 substance use disorder, 290 implicit bias, 294 integrated health models, 295 racial and ethnic disparities, 294 racial and ethnic groups alcohol, 293 cannabis, 293 cocaine, 293 opioids, 294 tobacco, 293 social determinants of health, 294, 295 societal and cultural stigma, 294 SUD and co-morbid mental illness, 295 and criminal justice system, 296 and legal system, 295 Index 386 Unhealthy substance use, 33 Urge, 99 Urine drug screen (UDS), 21 Urine immunoassays, 18 V Validity, 58 Varenicline (Chantix®), 113, 114 Veteran Affairs (VA) healthcare system, 290 Video games and internet addiction, 234 Volatile hydrocarbons, 212 Voltage-gated potassium channel, 39 W Wernicke-Korsakoff syndrome (WKS), 312, 328 Wide-spread stigmatization, 278 Wisconsin Initiative to Promote Healthy Lifestyles’ (WIPHL) Sample Behavioral Health Screen, 56 Withdrawal seizures, 126, 127 Women barriers to care, 263 epidemiology, 260 harm reduction & gender responsive treatment, 265–266 legal consequences, 262–263 physiological consequences, 261–262 screening and diagnosis, 264 social consequences, 262, 263 treatment alcohol, 266 cannabis, 267 opioids, 268, 269 stimulants, 267 tobacco, 267 Women for Sobriety (WFS), 78 Women who inject drugs (WWID), 262 Y Yale Food Addiction Scale (YFAS), 233 Z Zaleplon, 147 Zolpidem, 146 Zor receptor, 171 ... San Diego La Jolla, CA USA ISBN 97 8-3 -0 3 0-3 340 3-1 ISBN 97 8-3 -0 3 0-3 340 4-8 (eBook) https://doi.org/10.1007/97 8-3 -0 3 0-3 340 4-8 © Springer Nature Switzerland AG 2020 Chapter “Laboratory Testing for... www.medicaid.gov/state-resource-center/innovation-accelerator-program/iap-downloads/ reducing-substance-use-disorders/asam-resource-guide.pdf 12 (ASAM) ASoAM. Standards of care for the addiction specialist... Pharmacy, Los Angeles, CA, USA e-mail: dadiomov@usc.edu © The Author(s) 2020 C Marienfeld (ed.), Absolute Addiction Psychiatry Review, https://doi.org/10.1007/97 8-3 -0 3 0-3 340 4-8 _2 17 18 D Dadiomov Due