Download Plenary Presentation - O'Brien 2013

DSM-5:
Substance Related & Addictive
Disorders
Charles P. O’Brien, M.D., Ph.D.
University of Pennsylvania
Philadelphia, PA
• Familiar to everyone
• Criteria first published in 1994
• Text but not criteria updated in 2000
• Used worldwide for diagnosis,
education, research and
reimbursement purposes
DSM-5 Substance Disorder Workgroup members
Charles O’Brien, M.D., chair
Wilson Compton, M.D.
Marc Auriacombe, M.D
Bridget Grant, Ph.D. , Ph.D.
Guilherme Borges, Ph.D.
Deborah Hasin , Ph.D.
Katherine Buchholz, Ph.D.
Walter Ling, M.D.
Alan Budney, Ph.D.
Nancy Petry, Ph.D.
Thomas Crowley, M.D.
Marc Schuckit M.D.
Columbia University
Deborah Hasin, Ph.D.
BUT
Bio-markers in psychiatry are not
sufficiently reliable and available
for clinical practice
NIMH Research Domain Criteria
RDoC
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
(Copyright © 2013). American Psychiatric Association. All rights reserved
.
1.
2.
3.
4.
5.
6.
Correct errors in DSM-IV
“Dependence” is normal
No abuse category
Update with new science
Move gambling to the addictions group
Consider other “behavioral addictions”
- Most likely candidate: “Internet gaming disorder”
- Sex addiction (No)
- Food addiction (No)
3. Caffeine use disorder to Appendix (section 3)
4. Fetal Alcohol Syndrome (NDPAE) (Section 3)
Substance Use Disorder Criteria: DSM-IV
Abuse
Dependence
Failure to fulfill major role obligations
X
--
Hazardous use
X
Substance-related legal problems
X
Social/interpersonal substance-related problems
X
--
Tolerance
--
X
Withdrawal
--
X
Persistent desire/unsuccessful efforts to cut down
--
X
Using more or over for longer than was intended
--
X
Neglect of important activities
--
X
Great deal of time spent in substance activities
--
X
Psychological/Physical use-related problems
--
X
1+ criteria
3+ criteria
Diagnostic Criteria
Diagnostic Threshold
1+
---
3+
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision. Washington, DC, American Psychiatric Association, 2000.
Columbia University
Deborah Hasin, Ph.D.

What should be done about abuse, specifically, should
abuse be combined with dependence to create a single
disorder?

Should new criteria be added, e.g., craving or old criteria
(legal problems) be removed?

Can nicotine criteria be aligned with other substances?

Can cannabis and caffiene withdrawal be included?

What should be the diagnostic threshold, how should
severity be indicated?

International considerations
Columbia University
Deborah Hasin, Ph.D.
• Confusion about relationship of abuse to dependence because
abuse is assumed to be milder than dependence
– Leads to thinking abuse is prodromal to dependence
– Leads to thinking all cases of dependence meet criteria for abuse
• Reliability and validity of dependence is excellent
• Reliability and validity of abuse much lower, more variable
than dependence
• ~50% with abuse dx’ed with only 1 criterion: hazardous use
• Diagnostic “orphans” (2 dependence criteria, no dx)
Columbia University
Deborah Hasin, Ph.D.
• Many factor analyses showed abuse and dependence
criteria formed 1 factor, or 2 highly correlated factors
• Item Response Theory analysis extends factor analysis,
provideing more information
• Item characteristic curves (graphed) show relationship of
abuse and dependence criteria to each other
• Total information curves (TOC) allow comparison of two or
more sets of criteria
Columbia University
Deborah Hasin, Ph.D.
Sample
# Studies
Ns
Locations
17
722 - 43,093
Australia, Israel, US
2
5,195
Argentina, Mexico,
Poland, US
Adult substance abuse
treatment
5
372 - 1,511
Australia, US
Adult genetic studies
4
496 - 9,313
US
Adolescent general
population
4
353 - 3,641
France, US
Adolescent substance
abuse treatment
2
279 - 472
US
Adolescent mixed
2
5,587
US
Adult general population
Adult emergency room
Columbia University
Deborah Hasin, Ph.D.
NESARC (2001-2002) ICC
Current Alcohol Abuse, Dependence (N=22,526)
Probability of Symptom Endorsement
1.00
0.90
0.80
0.70
0.60
0.50
0.40
Quit control
Hazardous use
0.30
Tolerance
Withdrawal
0.20
0.10
3.00
2.80
2.60
2.40
2.20
2.00
1.80
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
-1.20
-1.40
-1.60
-1.80
-2.00
-2.20
-2.40
-2.60
-2.80
-3.00
0.00
Severity of Alcohol Use Disorder (Latent Trait)
Tolerance
Withdrawal
Larger/longer
Quit/control
Time spent
Activities given up
Physical/psychological problems
Neglect roles
Hazardous use
Legal problems
Social/Interpersonal problems
Saha, Grant et al., Drug and Alcohol Dependence 2007
Columbia University
Deborah Hasin, Ph.D.
1
Neglect roles
Hazardous Use
Legal Problems
Continued use despite problems
Tolerance
Withdrawal
Larger/Longer
Quit/control
Time spent
Activities given up
Physical/psychological problems
0.9
Probability of endorsement
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
-3
-2
-1
0
1
2
3
Severity of Alcohol use Disorder (Latent Trait)
Keyes KM…Hasin DS, Psychological Medicine 2010
Columbia University
Deborah Hasin, Ph.D.
NESARC ICC
Current Cannabis Abuse, Dependence (N=1,603)
Compton, Saha, Grant et al., Drug and Alcohol Dependence 2009
Columbia University
Deborah Hasin, Ph.D.
NESARC ICC
Lifetime Cocaine Abuse, Dependence (N=2,528)
1.00
0.90
Probability of Symptom Endorsement
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
3.00
2.80
2.60
2.40
2.20
2.00
1.80
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
-1.20
-1.40
-1.60
-1.80
-2.00
-2.20
-2.40
-2.60
-2.80
-3.00
0.00
Severity of Lifetime Drug Use Disorder- Cocaine/Crack (Latent Trait)
Tolerance
Withdrawal
Larger/longer
Quit/control
Time spent
Activities given up
Physical/psychological problems
Neglect roles
Hazardous use
Legal problems
Social/Interpersonal problems
Saha …Grant., Drug and Alcohol Dependence, 2012
Columbia University
Deborah Hasin, Ph.D.
DSM-III 1987
DSM-IV 1994
• Tolerance
• Withdrawal
• More use than intended
• Unsuccessful efforts to cut down
• Spends excessive time in acquisition
• Activities given up because of use
• Uses despite negative effects
DSM-IV
• Maladaptive use within 12 month period (one or
more)
1. Failure to fulfill major role obligations
2. Recurrent use in hazardous situations
3. Recurrent substance related legal problems
4. Continued use despite consistent social or
interpersonal problems
• Never met dependence criteria
Use
Abuse
(declarative)
Use
Addiction
(automatic)
Abuse
Use
Use
Abuse
Addiction
Addiction
Use
Use
Severity
DSM-5
•
Tolerance*
•
Withdrawal*
•
More use than intended
•
Craving for the substance
•
Unsuccessful efforts to cut down
•
Spends excessive time in acquisition
•
Activities given up because of use
•
Uses despite negative effects
•
Failure to fulfill major role obligations
•
Recurrent use in hazardous situations
•
Continued use despite consistent social or interpersonal problems
*not counted if prescribed by a physician
Examples of the various visual cues
from Normative Appetitive Picture System (NAPS)
Beverage (B)
Alcohol (A)
Visual Control (C)
Rest (R)
Time Course of the Presentation of Stimuli During fMRI
Sip of Preferred Beverage
C A
B C
B
R
0
A C B A
A C B
R
1
2
3
R
4
5
6
B
R
R
7
8
C A
9
B
C A
R
10
11
12 13
Time (min)
* Craving rated after each block
Comparisons: Alcohol
Alcohol
Vis Ctrl
- Beverage
- Vis Ctrl
- Rest
Beverage - Vis Ctrl
Beverage - Rest
Alcohol - Beverage Condition
Cingulate
Insula
Nucleus
Accumbens
Alcoholics (n=10)
Z=1.645 Ex .05
Controls (n=10)
Alcohol - Beverage Condition
Cingulate
Ventral Tegmental Area
Alcoholics (n=10)
Controls (n=10)
Z=1.645 Ex .05, Myrick et al,2004
1.
No more abuse and dependence
2.Severity measured by number of symptoms, 23 mild, 4-6 moderate, 7-11 severe
3.? Agonist maintenance (methadone,
Suboxone) requires“Moderate to severe opioid
use disorder”
1.
Anti-depressants
2.
Opioid analgesics
3.
Anti anxiety
4.
Anti hypertensive
BUT
Bio-markers in psychiatry are not
sufficiently reliable and available
for clinical practice
NIMH Research Domain Criteria
RDoC
DSM-5
•
(1) irritability, anger, or aggression
•
(2) nervousness or anxiety
•
(3) sleep difficulty (e.g., insomnia, disturbing dreams)
•
(4) decreased appetite or weight loss
•
(5) restlessness
•
(6) depressed mood
•
(7) at least one of the following physical symptoms: stomach pain,
shakiness/tremors, sweating, fever, chills, headache
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
• A. Daily Use of Caffeine
DSM-5
• B. 3 or more
(1) headache
(2) marked fatigue or drowsiness
(3) dysphoric or depressed mood, or irritability
(4) difficulty concentrating
(5) symptoms of nausea, vomiting, or muscle pain/
stiffness
• C. clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
• D. not due to the direct physiological effects of a general medical
condition
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
A. A problematic pattern of caffeine use leading to clinically
significant impairment or distress, as manifested by all of the
following three criteria occurring within a 12-month period:
1. A persistent desire or unsuccessful efforts to cut down or control caffeine use.
2. Continued caffeine use despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or
exacerbated by caffeine.
3. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for caffeine.
b. Caffeine (or a closely related) substance is taken to relieve or avoid
withdrawal symptoms.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
B. Other symptoms of the disorder:
1. Caffeine is often taken in larger amounts or over a longer period than was
intended.
2. Recurrent caffeine use resulting in a failure to fulfill major role obligations at work,
school, or home (e.g., repeated tardiness or absences from work or school
related to caffeine use or withdrawal).
3. Continued caffeine use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of caffeine (e.g.,
arguments with spouse about consequences of intoxication, medical problems,
cost).
4. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of caffeine to achieve desired effect.
b. Markedly diminished effect with continued use of the same amount of caffeine.
5. A great deal of time is spent in activities necessary to obtain caffeine, use caffeine,
or recover from its effects.
6. Craving or a strong desire or urge to use caffeine.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
A. Persistent and recurrent problematic gambling behavior leading to clinically
significant impairment or distress as indicated by four (or more) of the following
in a 12-month period:
1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
Gambling Disorder 312.31 (F63.0) 253
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling
experiences, handicapping or planning the next venture, thinking of ways to get money with
which to gamble).
5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity
because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
continued
)
B. The gambling behavior is not better explained by a manic episode.
Specify if:
Episodic: Meeting diagnostic criteria at more than one time point, with symptoms subsiding
between periods of gambling disorder for at least several months.
Persistent: Experiencing continuous symptoms to meet diagnostic criteria for multiple
years.
In early remission: After full criteria for gambling disorder were previously met, none
of the criteria for gambling disorder have been met for at least 3 months but for less
than 12 months.
In sustained remission: After full criteria for gambling disorder were previously met,
none of the criteria for gambling disorder have been met during a period of 12 months
or longer.
Specify current severity:
Mild: 4–5 criteria met.
Moderate: 6–7 criteria met.
Severe: 8–9 criteria met.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
Persistent and recurrent use of the Internet to engage in games, often with other players. Use of
the Internet for required activities in a business or profession is not included in this disorder, and
it also is not intended to apply to other recreational or social Internet use. Afflicted individuals
show clinically significant impairment or distress as indicated by five (or more) of the following in
a 12-month period:
1. Preoccupation with Internet games. (The individual thinks about previous gaming activity or anticipates
playing the next game; Internet gaming becomes the dominant activity in daily life).
Note: This disorder is distinct from Internet gambling, which is included under gambling disorder.
2. Withdrawal symptoms when Internet gaming is taken away. (These symptoms are typically described
as irritability, anxiety, or sadness, but there are no physical signs of pharmacological withdrawal.)
3. Tolerance—the need to spend increasing amounts of time engaged in Internet games.
4. Unsuccessful attempts to control the participation in Internet games.
5. Loss of interests in previous hobbies and entertainment as a result of, and with the exception of,
Internet games.
6. Continued excessive use of Internet games despite knowledge of psychosocial problems.
7. Has deceived family members, therapists, or others regarding the amount of Internet gaming.
8. Use of Internet games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt,
anxiety).
9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of
participation in Internet games.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
Note: For this disorder, gambling sites on the Internet are excluded. Only nongambling Internet games are included. Similarly, this disorder excludes sexual
Internet sites. Use of the Internet for required activities in a business or
profession is not included in this disorder, and the disorder is not intended to
include other recreational or social Internet use.
Specify current severity:
Internet gaming disorder can be mild, moderate, or severe depending on the
degree
of disruption of normal activities. Individuals with less severe Internet gaming
disorder
may exhibit fewer symptoms and less disruption of their lives. Those with severe
Internet
gaming disorder will have more hours spent on the computer and more severe
loss
of relationships or career or school opportunities
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
A. More than minimal exposure to alcohol during gestation, including prior to pregnancy
recognition. Confirmation of gestational exposure to alcohol may be obtained from maternal selfreport of alcohol use in pregnancy, medical or other records, or clinical observation.
B. Impaired neurocognitive functioning as manifested by one or more of the following:
1. Impairment in global intellectual performance (i.e., IQ of 70 or below, or a standard score of 70 or below
on a comprehensive developmental assessment).
2. Impairment in executive functioning (e.g., poor planning and organization; inflexibility; difficulty with
behavioral inhibition).
3. Impairment in learning (e.g., lower academic achievement than expected for intellectual level; specific
learning disability).
4. Memory impairment (e.g., problems remembering information learned recently; repeatedly making the
same mistakes; difficulty remembering lengthy verbal instructions).
5. Impairment in visual-spatial reasoning (e.g., disorganized or poorly planned drawings or constructions;
problems differentiating left from right).
C. Impaired self-regulation as manifested by one or more of the following:
1. Impairment in mood or behavioral regulation (e.g., mood lability; negative affect or irritability; frequent
behavioral outbursts).
2. Attention deficit (e.g., difficulty shifting attention; difficulty sustaining mental effort).
3. Impairment in impulse control (e.g., difficulty waiting turn; difficulty complying with rules).
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
D. Impairment in adaptive functioning as manifested by two or more of the following, one of
which must be (1) or (2):
1.Communication deficit (e.g., delayed acquisition of language; difficulty understanding spoken
language).
2.Impairment in social communication and interaction (e.g., overly friendly with strangers; difficult
reading social cues; difficulty understanding social consequences).
3.Impairment in daily living skills (e.g., delayed toileting, feeding, or bathing; difficulty managing daily
schedule).
4.Impairment in motor skills (e.g., poor fine motor development; delayed attainment of gross motor
milestones or ongoing deficits in gross motor function; deficits in coordination and balance).
E. Onset of the disorder (symptoms in Criteria B, C, and D) occurs in childhood.
F.The disturbance causes clinically significant distress or impairment in social, academic,
occupational, or other important areas of functioning.
G.The disorder is not better explained by the direct physiological effects associated with postnatal
use of a substance (e.g., a medication, alcohol or other drugs), a general medical condition (e.g.,
traumatic brain injury, delirium, dementia), another known teratogen
(e.g., fetal hydantoin syndrome), a genetic condition (e.g., Williams syndrome, Down
syndrome, Cornelia de Lange syndrome), or environmental neglect.
Reprinted with permission from the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, (Copyright ©
2013). American Psychiatric Association. All rights reserved
1.
2.
3.
4.
Neuroscience based diagnosis
150,000 diagnostic interviews
Bio markers not yet reliable
Heredity important, but no genetic impact
on treatment
5. Relapse prevention meds show efficacy
but rarely used
6. New findings if replicated > DSM 5.1
7. Potential pharmacogenetic indication,
Genotype, then select medication
1. No intermediate state-abuse, dependence; only a single dimension,
mild, moderate, severe
2. Two symptoms is diagnostic threshold for the combined disorder
3. “Dependence” only used for pharmacological dependence which is
not a disorder
4. Delete legal symptom and add craving
5. Group gambling disorder with substance use disorders
6. Add cannabis withdrawal.
7. Add Internet gaming disorder to section 3
8. Add Neurobehavioral Disorder Associated with Prenatal Alcohol
Exposure to Section 3
9. Add caffeine use disorder to section 3
Impact of Changes in DSM-5 on SUDs
• Interviewed 7,543 subjects for genetic studies of
substance dependence
• Modestly increased prevalence largely due to DSM-IV
“diagnostic orphans” receiving DSM-5 diagnoses
• Vast majority of switches to DSM-5 due to reduced
threshold and increased number of criteria
• Support for omission of the legal criterion due to
limited diagnostic impact
• Little impact of the addition of craving
Peer et al., Drug Alcohol Depend, 2013
Impact of Changes in DSM-5 on SUD
Prevalence
Peer et al., Drug Alcohol Depend, 2013
Why Classify Gambling Disorder with
SUDs?
• Strong comorbidity of the two disorders
• Measurable phenotype with high
heritability that underlies SUD and GD:
Different manifestations of an underlying
predisposition
• Evidence for shared neurobiology:
Imbalance between motivation/reward
systems and inhibitory systems
DSM-IV Pathological Gambling
(5 or more required for diagnosis)
1.
Preoccupation with gambling
2.
Need to gamble in increasing amounts
3.
Unsuccessful efforts to control gambling
4.
Restlessness or irritability when attempting to stop
5.
Gambling as a way to escape problems
DSM-IV Pathological Gambling
(5 or more required for diagnosis)
6. After losing, returns another day to get
even (“chasing losses”)
7. Lies to conceal extent of gambling
8. Commits illegal acts to finance gambling
9. Jeopardized or lost relationship, job,
education, or career because of gambling
10. Relies on others to relieve desperate
financial situation caused by gambling
DSM-5 Gambling Disorder (GD)
• Included in Substance-Related and
Addictive Disorders
• “Illegal Acts” criterion dropped, leaving a
total of only 9 criteria
• Number of criteria required for the
diagnosis reduced to 4
Impact of Changes in DSM-5 GD
• Interviewed 6,613 subjects from genetic
studies of substance dependence
• 1,507 had ever gambled $10 at least
monthly and were the focus of analyses
• Three subgroups: “No Diagnosis” (n=829,
55.0%), a “DSM-5-Only” (n=115, 7.6%),
and a “Both-Diagnoses” (n=563, 37.4%)
Rennert et al., Exp Clin Psychopharmacol, in press
Impact of Changes in DSM-5 GD
• Prevalence of DSM-5 GD was 20.4% higher
than DSM-IV Pathological Gambling (PG)
• DSM-5-Only group was intermediate on the
prevalence of comorbid substance use
disorders, distribution of DSM-IV PG criteria
endorsed, types of gambling reported, and
acknowledgment of a gambling problem
• DSM-5 appears to identify problem gamblers
who were not diagnosed under DSM-IV
Rennert et al., Exp Clin Psychopharmacol, in press
Other Changes
• Eliminated Polysubstance Dependence
• Added Cannabis and Caffeine Withdrawal and include
them as criteria for Cannabis Use and Caffeine Use
Disorders
• Aligned criteria for Tobacco Use Disorder with criteria for
other Substance Use Disorders
Summary of Major Changes
• Replaced Abuse/Dependence with SUD
• Increased criteria to 11 for SUD
– Omitted legal criterion and added craving
– Mild = 2-3, Moderate = 4-5, Severe = 6-11
• Renamed and moved Gambling Disorder to
Substance-Related and Addictive Disorders
• Reduced criteria to 9 for Gambling Disorder
– Omitted illicit acts
– Lowered threshold to 4 criteria required for
diagnosis
Minimal Skills:Detox
• Sedatives
– Alcohol, barbs, benzos
(gabapentin)
– Opioids
Clonidine
Lofexidine
Stimulants
Anti-depressants-TCA. SSRI
Cannabis
Relapse Prevention
• Naltrexone
– Alcohol,
– Opioids
Suboxone
Opioids
Stimulants, cocaine
Modafinil
Methamphetamine ?
Treatment of Alcoholism in USA
<10% receive treatment
•
Medications only for treatment of withdrawal
•
Relapse prevention medication rare
•
CNN Special on addiction: Relapses
•
Interviews with counselors at famous programs
CNN Special
Addiction: Life on the edge
5 patients followed for one year
Different parts of country
•
Admissions
•
Graduations
•
Relapses
•
•
Interviews with counselors at famous programs
Interview with the one patient who did NOT
relapse
GUPTA: And so he tried again. He checked himself into an
experimental program run by Brown University. This time he got
counseling once a week and a daily pill, a medicine called
naltrexone. About two months into it, Walter Kent suddenly
noticed the world around him looked and felt different.
KENT: And I had just turned around and I said, this is really
something for the first time in my life that I never had this
sensation where I didn’t want a drink. And this, to me, was like
a godsend because of the fact that for someone who had to have a
drink, now all of a sudden I don't need that -- I don't have that
feeling anymore.
GUPTA: He hasn’t had a drink in more than eight years. Even
after his doctor stopped the medication. He’s healthy, back at
work, fixing up carburetors.. And now he's part of a running
debate. Is addiction an illness you can treat with a pill or a
character flaw to be tackled with therapy and self-help?
Addiction: Life on the Edge – CNN Correspondent Dr. Sanjay Gupta aired April 19, 2009
GUPTA: Despite the evidence, most fancy rehab centers use
medication only rarely, if at all. The focus is much more on
therapy.
Head Counselor Minnesota: With the health care professional
staff here at Hazelden, our experience tells us having that
network of support in recovery is what really makes the
difference.
GUPTA: More so than medication?
CLARK: More so than just medication, exactly.
GUPTA: And that's the conventional wisdom.
Addiction: Life on the Edge – CNN Correspondent Dr. Sanjay Gupta aired April 19, 2009
California Program
GUPTA: What about medications?
Head Counselor California Program: We do not use them at the
Betty Ford Center.
No comment from the interviewer, no follow up questions.
Addiction: Life on the Edge – CNN Correspondent Dr. Sanjay Gupta aired April 19, 2009
Evidence-based treatments not
often used in US programs
• Medication only for detoxification
• Few programs prescribe relapse prevention medication
• Affordable Care Act, 2014 will cover all FDA approved
medications for substance use disorders.
http://www.med.upenn.edu/csa
or
[email protected]