A look at the latest in evidence-based care and innovative treatment for substance use and addiction.
SPECIAL REPORT: SUBSTANCE USE
Special Report Chairperson: Tony P. George, MD, FRCPC
This Special Report on addiction for Psychiatric Times™ focuses on evidence-based recovery-oriented care, stigma, and innovative policy and treatment. The articles included in this Special Report address important topics such as alcohol and cannabis, stigma in individuals with dual diagnosis, and substance misuse in college students—all of which are highly topical to practicing psychiatrists and other mental health professions.
The first article by Katie Witkiewitz, PhD, and colleagues from the University of New Mexico articulates the model of recovery-based care for individuals with alcohol use disorder. They make the important point that the traditional focus on abstinence-based outcomes not only lacks feasibility in the long term, but also may cause harm to these patients and compromise their overall well-being. Moreover, there is increasing scientific evidence to support harm reduction models.
Next, Darby Lowe, MSc, and colleagues from the Center for Addiction and Mental Health and the University of Toronto discuss an important group of patients for most psychiatrists: those with cooccurring disorders or dual diagnosis. The article makes the point that individuals who suffer from both addiction and mental health problems are very prone to stigma, given the well-documented stigma associated with either addiction or mental illness alone. Yet there is very little empirical evidence on stigma in these dual-disorder patients, and we know little about how to approach this problem of double stigma in these populations, which may be less than 50% of patients presenting for outpatient psychiatric care. The article is a call to action to address this problem with stronger advocacy for these patients and for further research in this area.
The article by Ashley Kivlichan and colleagues discusses recent developments in college students with respect to substance misuse, which often happens during an incredibly important time of transition for young people associated with their first independent living situation. The college years are a time of incredible promise and yet can be a time of significant stress and challenges, which can be risk factors for problematic alcohol and drug use. The authors highlight the importance of robust education, prevention, and treatment for addiction being made available to all college students, but especially those at high risk for developing problem substance use.
Finally, the article by Samantha Johnstone and colleagues discusses policy approaches to cannabis legalization and the importance of public education and availability of treatment for problem cannabis use. To date, 18 states and the District of Columbia (as well as Canada) have legalized recreational cannabis use, and there are significant economic, mental health, and social implications of this policy change—some positive and some not so positive. In particular, there is the concern that rates of problem cannabis use may increase in individuals with mental health and addictive disorders. Moreover, there is a controversy about whether cannabis legalization could reduce opioid use and overdose. These concerns will clearly require further study and are a reminder that health policy decisions need to proceed with caution if there is not good scientific evidence to back them.
This is an important and exciting time for understanding and treating addictions and yet there are many questions at the levels of etiology, prognosis, policy, and treatment that need to be addressed. Increasing research funding—as well as recruiting and retaining the best scientists, policy makers, and clinicians in this field—should be an important goal for psychiatry in the coming years.
Dr George is professor of psychiatry and medical sciences in the Temerty Faculty of Medicine at the University of Toronto and an addiction psychiatrist and clinician-scientist at the Center for Addiction and Mental Health in Toronto, Canada. He is also chair of the Scientific Advisory Committee of the Canadian Center for Substance Use and Addiction and deputy editor and incoming coprincipal editor of Neuropsychopharmacologythe journal of the American College of Neuropsychopharmacology. ❒