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

 

Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes.

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)

 

Structural and cultural barriers to the adoption of smoking cessation services in addiction treatment organizations.

Hannah Knudsen, Jamie Studts, Sara Boyd, Paul Roman Journal of Addictive Disorders (2010)

 

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)

 

Interview with Dr. Amy Fairchild on public health recommendations regarding electronic cigarettes in England and the United States

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)

 

Clinical Use of Extended-Release Injectable Naltrexone in the Treatment of Opioid Use Disorder: A Brief Guide

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)

 

Naloxone for opioid overdose.

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

 

The Impact of disulfiram treatment on the reinforcing effects of cocaine: a randomized clinical trial.

Haile, De La Garza, Mahoney, Neilson, Kosten, Newton (2012) PLOS One

 

Buprenorphine (Subutex, Suboxone, Zubsolv)

 

Buprenorphine

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

 

A Combination of buprenorphine and naltrexone blocks compulsive cocaine intake in rodents without producing dependence

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