Pharmacotherapy options for treatment of alcohol use disorder (AUD)
Mechanisms of action
Dosing and initiation, contraindications, side effects, monitoring
Cost and availability
Pharmacotherapy for Alcohol Use Disorder – Laura Evans YouTube Video
This presentation will encompass a review of current evidence for pharmacotherapy in alcohol use disorders and within the concurrent disorders population.
The three Health Canada approved medications for the treatment of alcohol use disorders have been available for decades and yet it is estimated that less than 10% of those with alcohol use disorders are offered pharmacotherapy. While a significant body of literature is available on this topic the many studies draw often contradictory conclusions. Additionally, the treatment of concurrent disorders in psychiatry has, historically, been a sequential approach in which substance use disorders were treated prior to addressing the co-morbid psychiatric illness. The paradigm has shifted in favor of a more integrated approach and there is mounting evidence for the use of pharmacotherapy in this population.
Pharmacological Treatment for Substance Based Addictions – Rob Tanquay YouTube Video
Major Depressive Disorder
Concurrent Disorders: Pharmacotherapy – Tashi Kinjo YouTube Video
Assessing concurrent disorders present the dual challenge of conducting a comprehensive assessment while considering client motivation. This is a continuous process that is integrated into the treatment planning.
CD Comprehensive Assessment – Gillian Hutton, Kristen Falconer & Stacy Whitman YouTube Video
This presentation will review the neurobiology and clinical assessment and management of chronic opioid use disorder.
What’s Up With Down: Treatment of Opioid Use Disorder in Alberta – Hakique Virani YouTube Video
Converging lines of evidence from neuroscience, molecular biology, genetics, and the social sciences tell us that early experiences are built into our brains and bodies to affect a lifetime of learning and health, for good or for ill. In this session, you will learn how brains are built: what kind of experiences promote healthy brain architecture, what kind of experiences derail it, and how these experiences get “under our skins” to affect learning and health outcomes – particularly those in addiction and mental health – across the lifespan.
The Effects of Early Experiences on Lifelong Learning and Health – Nicole Sherren YouTube Video
The Prescription Opioid Addiction Treatment Study (POATS), conducted at 10 U.S. sites under the auspices of the National Institute on Drug Abuse Clinical Trials Network, is the largest study yet conducted on treatment for those dependent on prescription opioids (N=653). POATS examined different lengths of treatment with buprenorphine-naloxone and different intensities of counseling for this population.
Treatment of Prescription Opioid Dependence – Roger Weiss YouTube Video
Cannabis is a widely used recreational drug that is currently undergoing legal reforms within both the medical community and general public domain but is still a source of great controversy. On an individual level, the majority of people who use cannabis regularly do so because of its ability to reduce anxiety. Similarly, at a clinical level, many individuals with anxiety conditions, in particular, post-traumatic stress disorder, anecdotally report significant benefit from using cannabis. The aim of the current talk is to provide an overview of what is known about the neural circuits regulating anxiety and how these are impacted by cannabis or derivatives from cannabis.
Cannabis and Anxiety: Insight from Basic Science – Matthew Hill YouTube Video
Electronic Cigarettes (e-Cigs) began to make gains in popularity after the introduction of numerous smoking cessation aids in approximately 2008. The device delivers nicotine in a non-smoked method and is believed to be safer than smoked tobacco products. Advertising has predominantly been focused on teens and youth and has transitioned from word of mouth, email and mall kiosks to large-scale television and multimedia campaigns. E-Cigs are largely unregulated in both Canada and the US and the process of research and regulatory policy development have lagged behind the exponential growth of the e-Cig industry. Debate continues over the issue of whether e-Cigs are another method that big tobacco is utilizing to sell product or whether electronic nicotine delivery systems are a safer alternative to smoked tobacco and have efficacy as a smoking cessation aid.
E-Cigarettes – Paul Sobey YouTube Video
There is strong and growing evidence to support the effectiveness of technology-based approaches for substance use disorders across the care continuum, including screening and assessment, education, treatment, and recovery support. Existing technology-based approaches are delivered by way of computers, laptops, tablets, or mobile smartphones, either as stand-alone interventions or as augments to care. Research has consistently demonstrated that technology-based approaches can work as well as, in some cases better than, care delivered by trained clinicians. There is also growing support for the cost-effectiveness of these treatment approaches. Despite strong empirical support for technology approaches, the field is relatively nascent with regard to guidance on the process of implementing these approaches in diverse care settings.
State of the Science for Technology-Based Approaches to Substance Use – Sarah Lord YouTube Video
Opioid use is a common clinical problem in the field of substance use disorders. Over the past decade, the use of methadone has been shown to be an effective treatment in managing opioid dependence. Often, however, psychiatric patients on methadone treatment are concomitantly taking antipsychotics to manage a variety of issues. Methadone-antipsychotic interactions (MAI) have been shown to cause several adverse effects and can impact the quality of life.
Methadone Antipsychotic Drug Reactions: A Systematic Review of the Literature – Natalia Ng YouTube Video
The proposed study aims to determine the effect of prescribed versus non-prescribed benzodiazepine use on patient retention in opioid agonist therapy.
Evaluating Influencing Factors on Opioid Agonist Therapy – Alexandra Franklyn YouTube Video
As with many Indigenous groups around the world, Aboriginal communities in Canada face significant challenges with trauma and substance use. The complexity of symptoms that accompany intergenerational trauma and substance use disorders represent major challenges in the treatment of both disorders. There appears to be strong evidence that strengthening cultural identity, incorporating traditional healing practices, community integration, and political empowerment can enhance and improve mental health and substance use disorders in Aboriginal populations. This study explored the feasibility of utilizing an empirically studied treatment model, Seeking Safety (2002a), and incorporating Indigenous traditional healing practices for the treatment of intergenerational trauma and substance use disorders.
Traditional Healing Methods and a Western Treatment Model – Teresa Marsh YouTube Video
Brain plasticity refers to the brain’s ability to change in response to experiences to provide a mechanism for adaptive change. But such adaptations are not always beneficial. Addictions are chronic relapsing disorders caused by genetic, epigenetic, and environmental factors that interact to lead to long-lasting experience-induced changes in certain brain regions in vulnerable individuals. I will review the types of plastic changes, including molecular, cellular, and behavioral changes, that occur in specific brain regions, including the prefrontal cortex, striatum, and brain stem, to mediate behavioral changes in addiction.
Searching for Principles of Brain Plasticity and Addiction – Bryan Kolb YouTube Video
Over the past several decades, significant advances have been made with respect to our understanding of the etiology, course and clinical
characteristics of pathological gambling. During the DSM-5 process, pathological gambling was renamed as gambling disorder and reclassified from an impulse control disorder to an addictive disorder, substantiating the notion of non-substance or behavioral addictions. While Internet- related behaviors were considered and research diagnostic criteria for Internet gaming disorder generated and included in section 3 of DSM-5, the Committee believed that additional data were needed prior to introducing such a disorder into the main text of DSM-5. As ICD-11 preparations are underway, there exists debate about how best to classify these and other conditions that may be considered impulse control or addictive disorders. The presentation will focus on relevant processes related to these issues in DSM-5 and ICD-11, including ongoing work by a WHO group, and will present information from clinical, epidemiological and neurobiological domains, with a view towards improving policy, prevention and treatment approach.
Behavioral Addictions in the Setting of DSM 5 and ICD 11 – Marc Potenza YouTube Video
Responsible gambling is promoted to prevent the development of problem gambling but there is no quantitative definition of what responsible or “low-risk” gambling is in terms of gambling behavior. In the field of alcohol research, low-risk drinking guidelines have been developed and widely disseminated to the public (e.g., maximum 2 drinks a day, 14 drinks per week). In light of the rapidly expanding gaming industry and significant rates of problem gambling in North America, the development of comparable low-risk gambling guidelines has been recommended. To this end, a set of low-risk gambling limits were produced using Canadian epidemiological data on the intensity of gambling behavior and related consequences. The findings of this work and their implications for problem gambling prevention activities will be presented.
Low-Risk Guidelines for Gambling Derived From Longitudinal Research – Shawn Currie YouTube Video
(ARCH) is a multidisciplinary consult team embedded within an inner city acute care hospital. With relationship-building as a core principle, addiction stabilization activities are complemented by social stabilization, health promotion, community linkage, and harm reduction activities. Launched in July 2014, ARCH sees approximately 20 new consults weekly. A process evaluation is underway to understand the patient and other stakeholder experiences with the team. Consenting patients are also being tracked longitudinally in a controlled study to determine ARCH’s impact on substance use, health services use, health promotion outcomes, and social outcomes. ARCH’s clinical and research successes hinge on strong academic, health sector, social sector, and data custodian partnerships, however, the most critical partnership remains that between team members and the inner city community it serves. We will discuss our experience with these partnerships and present preliminary patient outcomes.
ARCH Team – Kathryn Dong, Karine Meador & Ginetta Salvalaggio YouTube Video
For patients with opioid dependence in Northern Ontario, the interplay between access to mental health services and methadone maintenance therapy is complex. Psychiatric comorbidity including mood, anxiety, personality and post-traumatic stress disorders, are common with opioid dependence. Research indicates a greater compliance with treatment if it is provided by the same physician or at the same facility in an integrated service. A second line option includes working with psychiatric services to establish a referral process and frameworks for shared care.
Factors impacting treatment retention for patients with opioid dependency – Kathleen Anderson YouTube Video
Oxycodone was an effective analgesic but exposure to it, even as a legal prescription, has been found to lead to a high incidence of abuse, addiction, and death from overdose. Largely for this reason, OxyContin, and its generic counterpart has been removed from the Ontario Drug Formulary.
Physician prescribing habits have largely turned to other opioids, particularly HydromorphContin. This has created unexpected collateral damage. We have found that since the discontinuation of OxyContin the incidence of infectious complications of injection drug abuse, including endocarditis, sepsis and death have increased dramatically. We found that this is related to the physical properties of HydromorphContin as well as harm reduction kit use habits.
We need to learn from this when making future policies and practice changes. Harm reduction kits and education, need to evolve with changing abuse patterns, and Physicians prescribing opioids need to keep informed about abuse patterns and their consequences. Otherwise, we could continue to dig a deeper hole.
Digging a Deeper Hole – Sharon Koivu YouTube Video