Carl Sullivan

Medications for Substance Use Disorders

In this article, the authors briefly review the pharmacotherapeutic agents that are currently available for the treatment of substance use disorders. Nicotine replacement therapies are most effective for tobacco cessation. Naltrexone, acamprosate, and disulfiram are effective for reducing alcohol use. The most effective pharmacotherapies for opiate use disorders are agonist therapies, including methadone and buprenorphine. The authors also examine recent advances in medication development for other substance use disorders such as stimulant addiction. The role of medication adherence and behavioral treatments and the integration of behavioral and pharmacotherapeutic interventions are also discussed.

Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-year Retrospective Data Analysis

Objectives: To retrospectively review clinic records to assess the difference between face-to-face and telepsychiatry buprenorphine medication-assisted treatment (MAT) programs for the treatment of opioid use disorder on 3 outcomes: additional substance use, average time to achieve 30 and 90 consecutive days of abstinence, and treatment retention rates at 90 and 365 days. Methods: Medical records of patients (N = 100) who were participating in telepsychiatry and in face-to-face group-based outpatient buprenorphine MAT programs were reviewed and assessed using descriptive statistical analysis. Results: In comparison with the telepsychiatry MAT group, the face-to-face MAT group showed no significant difference in terms of additional substance use, time to 30 days (P = 0.09) and 90 days of abstinence (P = 0.22), or retention rates at 90 and 365 days (P = 0.99). Conclusions: We did not find any significant statistical difference between telepsychiatry buprenorphine MAT intervention through videoconference and face-to-face MAT treatment in our Comprehensive Opioid Addiction Treatment model for individuals diagnosed with opioid use disorder in terms of additional substance use, average time to 30 and 90 days of abstinence, and treatment retention rates.

Use of the Dexamethasone Suppression Test on a Combined Medicine-Psychiatry Inpatient Unit

The dexamethasone suppression test (DST) appears to be a sensitive and specific biological marker for endogenous depression that can have important diagnostic and treatment implications. The authors present three case studies of patients treated on a combined medicine-psychiatric inpatient unit, and who presented with complex psychobiological illnesses. They discuss the usefulness of the DST in the hospital management of these patients from a diagnostic and treatment perspective.

Medication-Assisted Treatment for Pregnant Women: An Interdisciplinary Group Based Model

ABSTRACT The treatment needs of pregnant women with opioid use disorders are increasing drastically. Medication-assisted treatment with buprenorphine is emerging as relatively a safe and effective treatment for pregnant women. New comprehensive models of treatment need to be developed to engage this high-risk, highly stigmatized population. The group modality is ideal for increasing access to treatment and addressing the specialized clinical needs experienced by pregnant women with substance use disorders while promoting interpersonal connection. A group-based model of treatment delivery for pregnant women with substance use disorders is presented here with preliminary outcomes data.

The West Virginia Prescription Drug Abuse Quitline: challenges and lessons learned from running a remote quitline.

The West Virginia Prescription Drug Abuse Quitline (WVPDAQ) is a resource that offers education and support to individuals and families affected by prescription drug abuse. The WVPDAQ began functioning September 11, 2008, through the use of mobile phone and laptop technology. Although some helplines and quitlines use some aspects of remote technology, most function through traditional call center and landline technology, making the WVPDAQ unique. This article describes the process evaluation of the WVPDAQ and outlines both the positive findings and challenges faced by the WVPDAQ. Lessons learned and future recommendations for remote quitline endeavors are also presented. It is hoped that the experiences and information regarding the WVPDAQ presented can provide best-practice insight for public health practitioners and evaluation personnel who are considering using alternative technologies to deliver quitline services.