Absolute Addiction Psychiatry Review: An Essential Board Exam Study Guide

Contents
Contributors
Part I: Introduction, Evaluation, Treatment
	1: Health Services for Addiction Treatment and Levels of Care
		Introduction
			The Complexity of Health Services for Persons with Addictive Disorders
		Key Concepts that Influence the Current Best Practices Treatment Models for Addictive Disorders
		Treatment Settings and Levels of Care for Those with Addictive Disorders
			The ASAM/Medicaid Adult Levels of Care
			Levels of Care for Adolescent Treatment
		Quality Performance Measures and Health Services for Addictive Disorders
		Review Questions
		References
	2: Laboratory Testing for Substance Use Disorders
		Introduction
		Principles of Laboratory Testing
		Drug-Specific Information
			Opioids
			Alcohol
			Benzodiazepines
			Marijuana
			Synthetic Cannabinoids
			Stimulants
			Dissociatives
			Hallucinogens and Other Drugs
		Review Questions
		References
	3: Epidemiology, Genetics, and Neurobiology of Substance Use and Disorders
		Introduction
		Epidemiology of Substance Use, Unhealthy Use, and Use Disorder
			Substance Use Disorders
			Substance Use and Recent Trends
			Unhealthy Substance Use
			Transition from Substance Use to SUD
			The Closing Gender Gap
			Culture, Race, Ethnicity, Immigration, and SUD
			The Treatment Gap for SUD
			Comorbidity
			Consequences of Use
		Genetics and Epigenetics of SUD
			Genetic Risk for SUD
			Exemplar Genes
				Genes Implicated in Substance Metabolism
				Genes Implicated in Addiction-Related Neurocircuits
				Genes with Unknown SUD-Related Function
			Gene-by-Environment Interaction
			Epigenetic Influences
			Relevance to Treatment
		Neurobiology of SUDs
			Tripartite Addiction Cycle and Associated Neuroanatomy and Circuitry
				Binge/Intoxication Stage and the Striatum
				Withdrawal/Negative Affect Stage and the Extended Amygdala
				Craving (Preoccupation/Anticipation) and the Prefrontal Cortex
			Neurodevelopment during Adolescence
			Summary of Relevant Neurotransmitter Systems
		Review Questions
		References
	4: Screening, Evaluation, and Diagnosis of Substance Use Disorder
		Screening
		Standardized, Psychometric Tests for Substance Use Disorders (SUD)
			Statistical and Psychometric Information for Test Selection
		Psychometric Assessment
		Evaluation and Diagnosis
			What Is an SUD and What It is Not?
			Substance Use Evaluation
		Review Questions
		References
	5: Psychosocial Treatment of Substance Use Disorders
		Introduction
		Cognitive Behavioral Therapy
			Empiric Evidence
			For Whom
		Motivation-Based Therapies
			Empiric Evidence
			For Whom
		Contingency Management
			Empiric Evidence
			For Whom
		Mindfulness-Based Therapies
			Empiric Evidence
			For Whom
		Psychodynamic Psychotherapy
			Empiric Evidence
			For Whom
		Mutual Aid Groups
			Empirical Support
			For Whom
		Systems-Based Therapy
			Family-Based Treatments
			Behavioral Couples Therapy
			Empiric Evidence
			For Whom
			Matrix Model
			For Whom
			Empiric Evidence
			Community Reinforcement and Family Training (CRAFT)
			Empiric Evidence
		Review Questions
		References
	6: Recovery from Addiction: Maintenance and Preventing Relapse
		Definition of Recovery
		Stages of Recovery
			Pre-contemplation Stage
			Contemplation Stage
			Preparation Stage
			Action Stage
			Maintenance and Relapse Prevention
		Pathways to Recovery
		Early Recovery: Monitoring for Treatment Adherence and Relapse
			Prescription Drug Monitoring Programs
			Toxicology
		Measurement of Recovery: Measuring Success in Treatment
		Biopsychosocial Vulnerabilities Leading to SUD
		Behavioral Changes from Relapse to Recovery
		Models of Relapse and Relapse Prevention
			Stage One: Emotional Relapse
			Stage Two: Mental Relapse
			Stage Three: Physical Relapse
		The Cognitive-Behavioral Framework of Relapse
		Conclusion
		Review Questions
		References
Part II: Addictions and Their Treatments
	7: Nicotine
		Introduction
			Epidemiology
			Consequences of Use
		Pharmacology
			Pharmacokinetics
			Pharmacodynamics
		Pathogenesis
			Intoxication
			Withdrawal
		Tobacco Use Disorder
			Diagnosis
			Assessment
		Treatment of Tobacco Use Disorder
			Overview of Treatment
		Nonpharmacological Treatment
		Pharmacological Treatment
			Nicotine Replacement Therapy
			Combination NRT
			Bupropion (Zyban®)
			Varenicline (Chantix®)
			Off-Label Treatments
		Electronic Cigarettes/Vaping
			Background and Formulations
			Current Evidence
			Risks/Disadvantages
		Review Questions
		References
	8: Alcohol
		Epidemiology
		The Genetics of Alcohol Use Disorder
		Pharmacokinetics
		Pharmacodynamics
		Alcohol Intoxication
			Management of Alcohol Intoxication
		Alcohol Withdrawal
			Management of Alcohol Withdrawal
		Laboratory Screening for Alcohol Use
		Diagnosing Alcohol Use Disorder
		Pharmacotherapy for Alcohol Use Disorder
		Review Questions
		References
	9: Benzodiazepines and Other Sedatives, Hypnotics, and Anxiolytics
		Epidemiology
		Risk Factors
		Mechanism of Action
		Pharmacokinetics
		Diagnosis
		Intoxication
			Clinical Syndrome
			Overdose
			Laboratory/Diagnostic Evaluation
			Treatment
		Withdrawal
			Clinical Syndrome
			Treatment
		Barbiturates
			Mechanism of Action
			Clinical Uses
			Adverse Effects
			Treatment
		Benzodiazepine Derivatives/“Z”-Drugs
			Pharmacology
			Adverse Effects
		Review Question #1
		Review Question #2
		Review Question #3
		Review Question #4
		Review Question #5
		Review Question #6
		References
	10: Cannabinoids
		Epidemiology and Recent Trends in Cannabinoid Use
		Pharmacology
			Overview of the Endocannabinoid System
		Plant-Based Cannabinoids
		Synthetic Cannabinoids
		Clinical Significance and What Psychiatrists Should Know About Cannabinoids
			Available Cannabis Products
		Associated Effects
			Acute Intoxication
		Behavioral Effects
		Motoric Effects and Relevance for Driving Ability
		Effects of Chronic Use
			Cognitive Effects
		Cannabis Use Disorder
		Cannabis Withdrawal Syndrome
		Adolescent Psychiatric Disorders
		Treatment of Cannabis Use Disorder
			Assessment of Cannabis Use
		Pharmacological Interventions
		Psychosocial Interventions
		Medical Use of Cannabinoids: Indications, Formulations, and Adverse Effects
		Interactions of Cannabinoids with Other Drugs
		Genetic Factors
		Review Questions
		References
	11: Opioids
		Introduction
			Pharmacology of Opioids
			Epidemiology of Opioid Use Disorder
		Diagnosis of Opioid Use Disorder
		Evaluation
			Diagnostic Interview: See Chap. 2
		Opioid Intoxication and Overdose
		Opioid Withdrawal
		Opioid Maintenance Treatment
			Opioid Agonists
			Opioid Antagonists
			Pregnant Women
		Review Questions
		References
	12: Stimulants: Caffeine, Cocaine, Amphetamine, and Other Stimulants
		Introduction
		Caffeine
		Diagnostic Considerations for Cocaine and Other Stimulants
		Cocaine
		Amphetamine and Amphetamine-Type Stimulants
		Review Questions
		References
	13: Steroids, Dissociatives, Club Drugs, Inhalants, and Hallucinogens
		Anabolic-Androgenic Steroids (AAS)
			Introduction
			Epidemiology
			Types of Anabolic Steroids and Sources
			Pharmacodynamics
			Patterns of Use
			Presentation and Adverse Medical Effects
			Assessment and Management
		Inhalants
			Introduction
			Epidemiology
			Pharmacokinetics and Pharmacodynamics
			Clinical Features
				Volatile Hydrocarbons
				Nitrites
				Nitrous Oxide
				Assessment and Management
		Hallucinogens
			Introduction
			Epidemiology
			LSD
			Psilocybin
			DMT
			Mescaline
			Salvia
			Clinical Features
			Assessment and Management
		Dissociative Anesthetics
			PCP
			Ketamine
			DXM
			Assessment and Management
		Club Drugs
			MDMA
			Assessment and Management
			GHB
			Assessment and Management
		Review Questions
		References
	14: Behavioral Addiction
		Introduction
		Gambling Addiction
		Compulsive Buying or Shopping Addiction
		Sex Addiction, Hypersexual Behaviors
		Eating Addictions
		Video Games and Internet Addiction
		Neurobiology and Genetics
		Psychosocial Treatments
			Group Psychotherapy
			Craving Behavioral Intervention
		Pharmacologic Treatments
			Opioid Antagonists
			N-acetylcysteine (NAC)
			Glutamate and N-methyl-D-aspartate (NMDA) Receptor Modulators
		Conclusion
		Review Questions
		References
Part III: Populations
	15: Adolescents and Students
		Introduction
		Epidemiology
		Neurobiological Considerations
		Psychological and Developmental Considerations
			Risk Factors and Protective Factors
		Environmental (Familial, Peer, Community, School) and Societal Considerations
			Risk Factors and Protective Factors
		Co-occurring Psychiatric Conditions
			ADHD
			Conduct Disorder
			Major Depressive and Bipolar Disorder
			Anxiety
			PTSD
		Risk Factors for Substance Use
		Screening
		Treatment Considerations
			Consent, Confidentiality, and Decision Making
			Behavioral Approaches
			Pharmacotherapy Approaches
			Alcohol
			Tobacco
			Benzodiazepines
		Review Questions
		References
	16: Women and Pregnancy
		Introduction
		Epidemiology
			Substance Use Among Women
			Substance Use among Pregnant Women
		Consequences and Considerations of Use in Women and Pregnancies
			Physiological Consequences
			Social Consequences
			Legal Consequences
			Barriers to Care for Women Who Use Substances
		Screening and Diagnosis
			Women
			Pregnant Women
		Approaches to Improve Outcomes and Treatment Considerations
			Harm Reduction and Gender Responsive Treatment
			Treatment for Substance Use Disorders Among Women and Pregnant Women
		Substance Use and Breastfeeding
		Conclusion
		Review Questions
		References
	17: LGBTQIA: Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual or Allied
		Introduction
		General Approach to the LGBTQIA Patient
		Taking a Sexual History
		Epidemiology of Substance Use in LGBTQIA Populations
		Gay Men
		Lesbians
		Review Questions
		References
	18: Underserved Populations
		Homelessness and Substance Use Disorder (SUD)
			Epidemiology of SUD Among Homeless Individuals
			Comorbidities and Mortality
			Barriers to Treatment
			Utilizing Existing Service Frameworks
			Treatment Interventions That Improve Outcomes for the Homeless Population
		Substance Use Disorders in Racial and Ethnic Groups
			Overview of Racial and Ethnic Disparities in Addiction
			Reasons Accounting for These Disparities
			Various Models of Care Hold Future Promise
		Substance Use Disorders and the Legal System
			Potential Interventions at Various Stages of the  Criminal Justice System
		Conclusion
		Review Questions
		References
	19: Older Adults
		Introduction
		Demographics of Substance Use Disorders in Older Adults
			Prevalence of Substance Use Among Older Adults
		Diagnosis and Screening of Substance Use Disorders in the Older Adult
		Physiology of Aging and Medical and Functional Complications of Substance Use for Geriatric Patients
		Substance Use and Neurocognitive Disorders
		Treatment Considerations for the Older Adult
		Review Questions
		References
	20: Professionals
		Introduction
		Identification and Assessment
		Treatment
		Return to Work Considerations
		Conclusion
		Review Questions
		References
Part IV: Other Topics
	21: Co-occurring Medical Disorders
		Alcohol
		Sedative-Hypnotics
		Stimulants
		Opioids
		Cannabis
		Tobacco
		PCP, Hallucinogens, Inhalants
		Caffeine
		Review Questions
		References
	22: Co-occurring Psychiatric Disorders
		Introduction
		Epidemiology
		Assessment and Diagnosis
		Treatment
		Outcomes
		Review Questions
		References
	23: Prevention, Public Health, and Public Policy
		Introduction
		Prevention
		Public Health
		Public Policy
		Prevention
			Primary Prevention
			Secondary Prevention
			Tertiary Prevention
				Prevention Through Harm Reduction
		Public Health
			Ten Essential Services of Public Health
			Case Example: Public Health Strategy to Reduce Transmission of Hepatitis C in New York City [5]
			Conclusions
		Public Policy
			Substance Use Treatment Access and Expansion Policies
			Access and Expansion Policies Related to Naloxone
			Conclusions
		Review Questions
		References
	24: Ethical and Legal Considerations
		Introduction
		Medical Ethics
		Stigma and Discrimination
		Addictions and the Law
		Medical Licensure and Credentialing in Addiction Psychiatry
		Privacy Laws in the Context of Addiction Psychiatry
		Review Questions
		References
Index