Management of substance use disorder
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Management of Substance Use Disorder. Module P: Addiction-Focused Pharmacotherapy. Patient with substance use disorder (SUD) (A). Is Opioid agonist therapy (OAT) appropriate for and acceptable to the patient? (C). Is the patient opioid dependent? (B).

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Management of Substance Use Disorder

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Management of substance use disorder

Management of Substance Use Disorder

Module P: Addiction-Focused Pharmacotherapy


Management of substance use disorder

Patient with

substance use disorder (SUD)

(A)

Is Opioid agonist therapy (OAT) appropriate for and

acceptable to the patient?

(C)

Is the patient opioid

dependent?

(B)

Initiate or continue opioid agonist

therapy

(D)


Initiate or continue opioid agonist therapy

Initiate or continue opioid agonist therapy

  • Available since 1960‚Äôs BUT confined to Opioid Treatment Programs, under federal and state controls.

  • Most effective medication in treating addiction, when used in well-run treatment program.


Indications for oat

Indications for OAT

  • Opioid dependence > 1 year

  • 2 or more unsuccessful opioid detoxification episodes within a 12-month period

  • Relapse to opioid dependence within 2 years from OAT discharge


Management of substance use disorder

Is naltrexone therapy

Appropriate for and

Acceptable to the patient?

(E)

Is the Patient Opioid

Dependent?

(B)

Assure patient is detoxified and

Opioid free before continuing (F)

Initiate naltrexone for opioid Dependence with patient Education and monitoring (G)

Arrange for detoxification if

Indicated

See Module S


Management of substance use disorder

  • Naltrexone has no positive psychoactive effects. Some highly motivated patients can be successful using naltrexone therapy.


Management of substance use disorder

  • Subpopulations with better prognosis for response include:

    • Patients highly motivated for abstinence

    • Patients in the criminal justice system, with monitored administration

    • Health care workers with employment-related monitoring


Indications for naltrexone

Indications for Naltrexone

  • Ability to achieve at least 7-10 days of abstinence to rule out the need for detoxification


Management of substance use disorder

Is the patient alcohol

Dependent?

(H)

Is Pharmacotherapy for Alcohol Dependence

Indicated?

(I)

Initiate pharmacotherapy for

Alcohol dependence with patient

Education monitoring

(J)


Indications for naltrexone in the treatment of alcohol dependence

Indications for Naltrexone in the Treatment of Alcohol Dependence

  • Ability to achieve at least 3-5 days of abstinence to rule out the need for detoxification

  • Drinking within the past 30 days and/or reports of craving

  • Most effective when the patient is engaged in addiction-focused counseling


Indications for disulfiram in the treatment of alcohol dependence

Indications for Disulfiram in the Treatment of Alcohol Dependence

  • Alcohol dependence with:

    • Abstinence >24 hours

    • Combined cocaine and alcohol

    • Failure of or contraindication to naltrexone

    • Previous response to disulfiram


Management of substance use disorder

Naltrexone in the

Treatment of Alcohol

Dependence

1.0

0.8

0.6

0.4

Naltrexone HCl (N=35)

Placebo (N=35)

0.2

0.0

0

1

2

3

4

5

6

7

8

9

10

11

12

No. of Weeks Receiving Medication

Volpicelli et al. Arch Gen Psychiatry. 1992;49:876-880


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