Volume 4, Number 2 - June 2008
Progress in Analgesia
[PDF - 56K]
Nora D. Volkow, M.D.
The State of the Art in Treatment, Today and Tomorrow
[PDF - 44K]
David Anderson
Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders
[PDF - 740K]
Seddon R. Savage, M.D., M.S., Kenneth L. Kirsh, Ph.D., and Steven D. Passik, Ph.D.
Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist's efficacy with many patients, both in the substance abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.
The Search for Medications to Treat Stimulant Dependence
[PDF - 108K]
Kyle M. Kampman, M.D.
Progress in understanding the neurobiology of stimulant dependence has enabled researchers to identify medications whose pharmacological effects suggest that they might help patients initiate abstinence or avoid relapse. Several of these medications and a vaccine have shown encouraging results in controlled clinical trials with cocaine-dependent patients. The search for a medical treatment for methamphetamine dependence started more recently, due to the later emergence of this epidemic, but at least one candidate medication has shown promise in early clinical testing. Treatment approaches that combine efficacious medications and empirically proven behavioral interventions, such as voucher-based reinforcement therapy, will almost certainly produce the best results.
Science and Practice in Action
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Dialectical Behavior Therapy for Substance Abusers
[PDF - 232K]
Linda A. Dimeff and Marsha M. Linehan
Dialectical behavior therapy (DBT) is a well-established treatment for individuals with multiple and severe psychosocial disorders, including those who are chronically suicidal. Because many such patients have substance use disorders (SUDs), the authors developed DBT for Substance Abusers, which incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. Among these are dialectical abstinence, "clear mind," and attachment strategies that include off-site counseling as well as active attempts to find patients who miss sessions. Several randomized clinical trials have found that DBT for Substance Abusers decreased substance abuse in patients with borderline personality disorder. The treatment also may be helpful for patients who have other severe disorders co-occurring with SUDs or who have not responded to other evidence-based SUD therapies.
This Issue's Authors and Respondents
[PDF - 56K]
Should I or Shouldn't I?
[PDF - 80K]
Continuing Education Quiz for Counselors
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Substance abuse counselors can earn two nationally certified continuing education (CE) hours by reading the indicated articles and completing the multiple-choice quiz. This is an open-book exam. Complete the quiz by circling one or more of the multiple-choice answers. Be sure to answer all questions; unanswered questions will be scored as incorrect. You must score at least 70 percent to earn CE hours. Please note that we must receive your quiz by September 15, 2008.
[PDF - 72K]
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