Medications approved by the FDA for treatment of alcohol and opioid dependence, including acamprosate, disulfiram, naltrexone, methadone, and buprenorphine, have not been widely studied in the dually diagnosed population. Often, study participation criteria exclude individuals with co-occurring substance use disorders and mental illness, and it is only in recent years that research specifically focused on this population has become more common. Pharmacotherapy has also been underutilized in practice. A survey of 955 bipolar individuals found that while 8% met criteria for a current alcohol use disorder and 5% met criteria for a current non-alcohol substance use disorder, only 0.4% received disulfiram, methadone, naltrexone, and/or buprenorphine (Simon et al., 2004). The high prevalence of comorbid substance abuse and mental illness, and the challenges associated with treatment, mean that underutilization and lack of research are likely to have a critical impact on client outcomes. This paper explores evidence for the safety and efficacy of pharmacotherapy for substance use disorders in clients with comorbid mental illness. It was hypothesized that use of such medications carries risks unique to this client group, and that pharmacotherapy nonetheless has a role in treating substance dependence for these clients. The MNCat and Google Scholar research databases were searched for publications addressing the use of FDA-approved medications for alcohol and opioid dependence in clients with comorbid psychiatric diagnoses. Controlled, double-blind, and large-scale studies were prioritized. When this information was unavailable, theoretical papers, literature reviews, and case histories were included. The paper finds that research on ... ... middle of paper ... ...issues. These beneficial effects were not anticipated. Specifically, the symptoms of psychotic spectrum disorders and PTSD seem to helped by a number of pharmacotherapeutic options. Above all, however, more research is needed. The large gaps in our current understandings of these medications are clear, but there is also room to review other evidence in this area. Further reviews would benefit from a broader range of topics. First, theoretical and neurological understandings of psychiatric disorders and the pharmaceuticals discussed in this paper could be explored in order to add context for case studies when larger research studies are not available. Second, the effect of psychiatric medications on substance use would be useful for prescribing clinicians. Third, further literature reviews would benefit from the inclusion of pharmacotherapy for nicotine dependence.
Stahl, S. M., & Mignon, L. (2010). Antipsychotics: Treating psychosis, mania and depression (2nd ed.).
Fortinash, K. M., & Holoday Worret, P. A. (Eds.). (2012). Substance-related disorders and addictive behaviors. Psychiatric mental health nursing (5th ed., pp. 319-362). St. Louis, MO: Elsevier Mosby.
McGovern, M. P., PhD, & Carroll, K. M., PhD. (2003). Evidence- base Practices for Substance Use Disorders. Psychiatric Clinics of North America. Retrieved from http://www.dartmouth.edu/~dcare/pdfs/fp/McGovernMark-Evidence-BasedPractices.pdf
Over 17 million Americans suffer from an alcohol abuse disorder, most of which is alcoholism. (NIH, 2014) It is reported that over 15% of those 17 million people never seek treatment for their disorder. Those who do find themselves faced with the task of beating their alcohol abuse disorder are faced with many options as far as treatment goes. One of the most medically controversial is Disulfiram (Antabuse). This medication reacts negatively with alcohol and will send the person’s body into a state of turmoil to hopefully combat their severe drinking problem. As every medication does, Antabuse has its few problems here and there, but overall, this treatment seems to be an extremely effective way to rid those of alcohol abuse disorders.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of Bipolar Disorder. The Lancet, 381(9878), 1672-1682. doi: 10.1016/S0140-6736(13)60857-0
Opioid addiction is a tragedy that affects countless of Americans on a daily basis. Almost everyone is acquainted to someone, who suffers from opioid addiction. Everyone, but specifically family and friends of the victims to opioid addiction need to understand why their loved ones are so susceptible to becoming addicted to opioids. The word opioid in itself is complex to define, but it entails a variety of prescription medications. Most opioids are used as pain management medications and qualify as CII medications also known as narcotics. They are supposed to be used on an “as needed” basis, but that is not the case for many users of opioids. Opioids cause great fear in the health community because they are easily addictive and
Miklowitz, D. G. and Otto, M.W. (2006). New Psychosocial Interventions for Bipolar Disorder: A review of literature and introduction of the systematic treatment enhancement program. Journal of Cognitive Psychotherapy. 20, 214-230.
Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We Come? Psychopharmacology Bulletin. 30 (1): 27-38.
According to Gamble and Brennan (2000), the effectiveness of medication for schizophrenia to relieve patients from psychotic symptoms is limited. Although patients have adequate medication, some received little or no benefit from it and almost half of them still experience psychotic symptoms. They are also more likely to suffer relapse (Gamble and Brennan, 2000). Furthermore, Valmaggia, et al. (2005) found that 50% of patients who fully adhere to anti-psychotic medication regimes still have ongoing positi...
This leads to the second school of thought on medically assisted treatment. There has been a great deal of debate about the medication used to treat Opiate addiction, methadone. Many feel that the drug methadone is simply trading one drug in for another, as the addiction to methadone is quick and almost more powerful than an opiate addiction (Nelson, 1994). The withdrawals effects are far more intense with methadone and for this reason it is a lifetime maintenance medication. Some suggest that more rehabilitative programs are needed that would address the social problems the users have to help them recover, instead of the methadone program that is viewed...
Arias, M.D., A. J., & Kranzler, M.D, H. R. (n.d). Treatment of co-occurring alcohol and other drug Use disorders. Retrieved from http://pubs.niaaa.nih.gov/publications/arh312/155-167.htm
As a result of research and advancements in biomedical science, psychotropic medications have become a primary tool in the holistic treatment of mental health concerns (Kaut & Dickinson, 2007). Education regarding psychopharmacology is now recommended for all mental health professionals in accordance with the ethical codes for the profession (King & Anderson, 2004). Counselors must also navigate their roles with regard to medication and client concerns carefully to avoid liability, while acting in the best interest of the client.
Canada, H. (2009, December 16). Best Practices- Concurrent Mental Health and Substance Use Disorders. Retrieved from Intergrated Treatment: www.hc-sc.gc.ca
To begin with, in order for a facility to be successful in treating people with addictions whether it be alcohol, or drugs the facility must have a treatment plan to use and guide both counselors and the client alike to be successful in the program.
Substance abuse complicates almost every aspect of care for the person with a mental disorder. When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs; these changes are what lead to compulsive drug use. Drug abuse plays a major role when concerning mental health. It is very difficult for these individuals to engage in treatment. Diagnosis for a treatment is difficult because it takes time to disengage the interacting effects of substance abuse and the mental illness. It may also be difficult for substance abusers to be accommodated at home and it may not be tolerated in the community of residents of rehabilitation programs. The author states, that they end up losing their support systems and suffer frequent relapses and hospitalizations (Agnes B. Hatfield, 1993).