Ninth Slice of Cheese: Medication
Memo to Self: “I need to quit."
Dr. Howell discusses the importance (and difficulty) of incorporating nicotine cessation into the Recovery Management of people in early sobriety.
Smoking cessation therapies benefit substance use disorder clients
Substance Abuse and Mental Health Services Administration - Blending Initiative
Smoking and addiction I: for people in recovery
William L. White (2011), from www.williamwhitepapers.com
Smoking and addiction II: for addiction professionals
William L. White (2011), from www.williamwhitepapers.com
Janice Tsoh, Felicia Chi, Jennifer Mertens, Constance Weisner
Drug and Alcohol Dependency (2011)
Smoking cessation during substance abuse treatment: What you need to know
Catherine T. Baca, Carolina Yahne
Journal of Substance Abuse Treatment (2009)
Tobacco Use Cessation During Substance Abuse Treatment Counseling
Substance Abuse and Mental Health Services Administration (2011)
Hannah Knudsen, Jamie Studts, Sara Boyd, Paul Roman Journal of Addictive Disorders (2010)
Smoking cessation services in addiction treatment: challenges for organizations and the counseling workforce Hannah K. Knudsen and William L. White (2012)
An Addiction treatment campus goes tobacco-free: lessons learned
Brian Coon (2014) Addiction Professional magazine
Smoking cessation therapies benefit substance use disorder clients
Substance Abuse and Mental Health Services Administration - Blending Initiative
Evidence, Policy, and E-Cigarettes - will England reframe the debate?
Sharon Green, Ronald Bayer, Amy Fairchild
New England Journal of Medicine (2016)
New England Journal of Medicine podcast
What we did at Le Mont with regard to nicotine cessation: One thing that concerned me was the high rate of smoking among the people who came to the house who had recently graduated from residential treatment. We required our residents, as part of their establishing a relationship with a local Addiction Medicine Specialist, to at least discuss the subject of nicotine cessation. Since we closed Le Mont in 2012, our policy on nicotine use among residents and staff did not have the opportuneity to evolve beyond that requirement.
Dr. Howell lists the medications currently approved by the FDA for treating substance use disorders.
Medication for the treatment of alcohol use disorder: a brief guide.
Substance Abuse and Mental Health Services Administration
Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends
Substance Abuse and Mental Health Services Administration (2015)
Medication Assisted Treatment for Substance Use Disorders
Mann, Frieden, Hyde, Volkow, Koob (2014) Center for Medicare and Medicaid Services
Medication-Assisted Therapies - Tackling the Opioid-Overdose Epidemic
Volkow, Frieden, Hyde, Cha (2014) New England Journal of Medicine
Additional information about the medications Dr. Howell mentioned:
Extended-release Naltrexone (Vivitrol)
Substance Abuse and Mental Health Services Administration (2015)
Extended-release injectable naltrexone: a significant opportunity for treating opioid use disorder
Melinda Campopiano, Brandon Johnson; Substance Abuse and Mental Health Services Administration (2015)
Naltrexone for Extended-release injectable suspension for treatment of alcohol dependence
Substance Abuse and Mental Health Services Administration (2007)
Naloxone (Narcan)
Substance Abuse and Mental Health Services Administration website
Acamprosate (Campral)
Acamprosate: a new medication for alcohol use disorders
Substance Abuse and Mental Health Services Administration (2005)
The Clinical pharmacology of acamprosate.
Nicola Kalk, Anne Lingford-Hughes, British Journal of Clinical Pharmacology (2012)
Acamprosate: an alcoholism treatment that may not be what we thought.
Markus Heilig, Neuropsychopharmacology (2014)
Disulfiram (Antabuse)
Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis.
Skinner, Lahmek, Pham, Aubin (2014) PLOS One
Haile, De La Garza, Mahoney, Neilson, Kosten, Newton (2012) PLOS One
Buprenorphine (Subutex, Suboxone, Zubsolv)
Substance Abuse and Mental Health Services Administration website
Buprenorphine for opioid dependence
Walter Ling (2009) Expert Review of Neurotherapeutics
What Buprenorphine is and why it’s important
National Institute on Drug Abuse website
Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine
Unger, Jung, Winklbaur. Fischer (2010) Journal of Addictive Disorders
Discontinuation of buprenorphine maintenance therapy: perspectives and outcomes
Bentzley, Barth, Back, Book (2015) Journal of Substance Abuse Treatment
IIllicit use of buprenorphine/naloxone among injecting and non-injecting opioid users
Bazazi, Yokell, Fu, Rich, Zaller (2011) Journal of Addiction Medicine
Wee, Vendruscolo, Misra, Schlosberg, Koob (2012) Science: Translational Medicine
Methadone:
Recovery-Oriented Methadone Maintenance
William L. White, Lisa Mojor-Torres (2010) Great Lakes Addiction Technology Transfer Center
What we did at Le Mont with regard to medication: As the provider of a recovery management/recovery residence, I did not feel it was our right to insinuate ourselves into a relationship between patient and doctor. If a resident was earnestly participating in the other recovery management elements required to live in our home, and if they had in good faith established a relationship with a local Addiction Medicine Specialist, and if out of that relationship emerged the shared decision to use a particular medication, even a controlled substance, as part of that resident’s overall recovery plan, then it was our job to facilitate that part of the resident’s plan, not to judge the clinical decision made.
Nevertheless, from a safety perspective, there is risk in bringing an addictive medication onto the premises. To offset that risk, we developed a “Controlled Substances Protocol.” The medication was stored in a secure manner (a safe in a locked staff-only office). Every dose of the medication taken by the resident was witnessed and recorded. Staff conducted pill/strip counts daily and recorded the result. As part of regular drug testing of the staff, the medication in question was added to the testing panel. It was essential for our staff to have a good relationship and open communication with the prescriber to report the resident’s Recovery Plan performance.
We found, with this level of structure, very few problems regarding medication occurred. We saw no diversion of the medication. There were no conflicts between staff and residents about the medication, nor were there conflicts between residents on medication and those not on medication. We found that good Recovery Management principles reduced, if not eliminated, the problems often purported to medication-assisted treatment.
Dr. Howell describes the evolution of her own thinking with regard to the controversy of Medication-Assisted Treatment.
Medication-Assisted Treatment for Opioid Addiction
The White House, Office of National Drug Control Policy (2012)
Twelve Step Recovery and Medication-Assisted Therapies
Louis E. Baxter (2014) American Society of Addiction Medicine