Front Matter
Publication: Pharmacotherapy for Complex Substance Use Disorders: A Practical Guide
Pharmacotherapy for Complex Substance Use Disorders
A Practical Guide
Pharmacotherapy for Complex Substance Use Disorders
A Practical Guide
Edited by
Thanh Thuy Truong, M.D.
Benjamin T. Li, M.D.
Daryl Shorter, M.D.
Nidal Moukaddam, M.D., Ph.D.
Thomas R. Kosten, M.D.
Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.
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Library of Congress Cataloging-in-Publication Data
Names: Truong, Thanh Thuy, editor. | Li, Benjamin T., editor. | Shorter, Daryl, editor. | Moukaddam, Nidal, editor. | Kosten, Thomas R., editor. | American Psychiatric Association, issuing body.
Title: Pharmacotherapy for complex substance use disorders : a practical guide / Thanh Thuy Truong, Benjamin T. Li, Daryl Shorter, Nidal Moukaddam, Thomas R. Kosten.
Description: Washington, D.C. : American Psychiatric Association Publishing, 2023. | Includes bibliographical references and index.
Identifiers: LCCN 2023018637 (print) | LCCN 2023018638 (ebook) | ISBN 9781615374953 (paperback) | ISBN 9781615379989 (ebook)
Subjects: MESH: Substance-Related Disorders—drug therapy
Classification: LCC RC564 (print) | LCC RC564 (ebook) | NLM WM 270 | DDC 616.86—dc23/eng/20230630
LC record available at https://lccn.loc.gov/2023018637
LC ebook record available at https://lccn.loc.gov/2023018638
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors vii
Preface ix
1 Overview of Substance Use Disorders 1
Thanh Thuy Truong, M.D.
2 General Approach to Patients With Multi-substance Use Disorders 11
Hazem Shahin, M.D.
3 Neurobiology of Addiction and Principles of Pharmacology 31
Tabark Altai, M.D.
Nidal Moukaddam, M.D., Ph.D.
4 Laboratory Testing 45
Benjamin Li, M.D.
5 Alcohol and Co-occurring Substance Use 73
Benjamin Li, M.D.
6 Stimulants and Co-occurring Substance Use 109
Thanh Thuy Truong, M.D.
7 Opioids and Co-occurring Substance Use 143
Thanh Thuy Truong, M.D.
M. Asif Khan, M.D., M.R.O.
Nidal Moukaddam, M.D., Ph.D.
8 Trinity Combinations 171
Daryl Shorter, M.D.
9 Novel Psychoactive Substances 187
Thanh Thuy Truong, M.D.
10 Co-occurring Psychiatric and Substance Use Disorders 199
Nancy C. Shenoi, M.D.
Mark Yurewicz, M.D.
11 HIV and Substance Use Disorders 235
Richa Vijayvargiya, M.D.
Thanh Thuy Truong, M.D.
12 Substance Use Disorders in Pregnancy 249
Andres Ojeda, M.D.
Claire K. Morice, M.D.
Thanh Thuy Truong, M.D.
13 Addictive Disorders in Adolescents 281
Crystal Obiozor, M.D.
Edore Onigu-Otite, M.D.
14 Substance Use Disorders in the LGBTQ+ Population 317
Daryl Shorter, M.D.
15 Pain and Substance Use Disorders 331
Benjamin Li, M.D.
Britney Lambert, M.D.
Thanh Thuy Truong, M.D.
Index 355
Contributors
Tabark Altai, M.D.
Resident, University of San Francisco, Fresno, California
M. Asif Khan, M.D., M.R.O.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Britney Lambert, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Benjamin Li, M.D.
Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Claire K. Morice, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Nidal Moukaddam, M.D., Ph.D.
Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; and Director of Adult Psychiatry Outpatient Services, Harris Health System, Houston, Texas
Crystal Obiozor, M.D.
Child and Adolescent Psychiatry Fellow, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Andres Ojeda, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Edore Onigu-Otite, M.D.
Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences; Medical Director, Pediatric Addiction Clinic; and Associate Course Director, Ben Taub Mental Health Services, Baylor College of Medicine, Houston, Texas
Hazem Shahin, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Nancy C. Shenoi, M.D.
Addiction Psychiatry Fellow, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Daryl Shorter, M.D.
Medical Director, Addiction Services, The Menninger Clinic, and Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Thanh Thuy Truong, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Richa Vijayvargiya, M.D.
Assistant Professor, Department of Psychiatry, University of Florida, Gainesville, Florida
Mark Yurewicz, M.D.
Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
Disclosures
The contributors to this volume have indicated they have no financial interest in or other affiliation with a commercial supporter, manufacturer of a commercial product, and/or provider of a commercial service.
Preface
Welcome to Pharmacotherapy for Complex Substance Use Disorders: A Practical Guide. Our goal for this text is to provide practical clinical pearls and evidence-based recommendations to help clinicians feel more confident in their management of patients with complex substance use disorders (SUDs). Our team of addiction psychiatrists identified relatively limited literature on the pharmacotherapy of multi-substance use disorders and special populations such as adolescents, pregnant patients, and members of the LGBTQ+ community. With few FDA-approved treatments for SUDs and no explicit treatment guidelines, we hope to bring our clinical experience to mental health and primary care clinicians. Most of all, we hope to allay fears and instill hope in clinicians and patients during their recovery journeys.
How to Use This Book
In this text, we primarily review maintenance pharmacological treatment for SUDs. We do not detail the management of intoxication and withdrawal syndromes and defer that information to other texts, such as The ASAM Principles of Addiction Medicine (Miller 2018). The authors of Chapter 5, “Alcohol and Co-occurring Substance Use”; Chapter 6, “Stimulants and Co-occurring Substance Use”; and Chapter 7, “Opioids and Co-Occurring Substance Use” review pharmacotherapeutic interventions for the substances mentioned in their respective chapter titles as the primary substance, while considering the co-occurring substances as secondary. We determine the primary substance based on factors such as the most significant functional impairment, the strongest craving, or as perceived by the patient. The authors of Chapter 12, “Substance Use Disorders in Pregnancy”; Chapter 13, “Addictive Disorders in Adolescents”; and Chapter 14, “Substance Use Disorders in the LGBTQ+ Population” examine common SUDs and unique considerations in selecting pharmacological or behavioral interventions for these patient populations.
Because the nomenclature and criteria for SUDs changed from DSM-IV (American Psychiatric Association 1994) to DSM-5 (American Psychiatric Association 2013), we use words such as abuse, dependence, and relapse when citing older studies that followed DSM-IV criteria or used older terminology. Otherwise, we prefer substance use disorder, recurrence, and return to use.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013
Miller S: The ASAM Principles of Addiction Medicine, 6th Edition. Philadelphia, PA, Lippincott Williams and Wilkins, 2018
Information & Authors
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Published In
Pharmacotherapy for Complex Substance Use Disorders: A Practical Guide
Pages: i - x
History
Published in print: 10 October 2023
Published online: 5 December 2024
© American Psychiatric Association Publishing
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