I look up and see nostrils flaring with black smoke as fiery red eyes glare into my own. The beast displays it enormous wings, eclipsing the light of the sun. Though I sit atop my steed the two-headed dragon towers over me. Their names are Obsessive Compulsive Disorder and Tourette Disorder. They speak no words, yet something in their gaze tells me that there’s no hope,…
Introduction A high comorbidity for attention deficit hyperactivity disorder (ADHD) and anxiety has been reported in epidemiologic studies and clinical psychiatric ADHD and pediatric samples. This comorbidity is not innocuous but confers greater executive functional deficits, greater social difficulties, and poorer quality of life (QoL) and precedes later substance use. Despite the significant impairments, there is limited knowledge on the underlying neurobiology and treatment management for…
Introduction School attendance is the foundation of a student’s ability to receive education and the benefits that such education provides. However, this most basic ability of attending school consistently proves elusive for many students. There are myriad proximal and distal factors that contribute to school absenteeism, which include physical health, mental disorders, and family, school, and community variables. For practitioners, when a patient presents with problematic…
The concept of gender may appear to be simple for those who have never thought about the fact that their biologic sex is congruent with their gender identity; however, it is a complex term with complex meanings. It can morph and change over time and can be expressed in an infinite number of ways. For children and adolescents, gender identity can be especially confusing. Historically, the…
Introduction Alcohol use disorders (AUD) are a major preventable cause of morbidity and mortality. Effective interventions exist ; however, there are many barriers to optimal outcomes. Well-established psychosocial and pharmacological interventions for AUD can be limited by disengagement, tolerability, nonadherence, and high relapse rates. There is a need for additional interventions that are safe, well tolerated, acceptable to patients, and effective. Natural molecular treatments—or functional treatments,…
If you can't measure it, you can't improve it Lord Kelvin (William Thomson) Introduction Alcohol and other drug (AOD) use disorders and related conditions pose a major threat to public health and safety among middle and high-income countries globally. These growing problems confer a prodigious burden of disease, disability, and premature mortality as well as an increasing economic toll related to lost productivity, criminal justice, and…
Introduction Over 1/3 of adults in the United States are considered obese, defined as body mass index (BMI) ≥30, and an additional 1/3 are considered overweight, defined as BMI ≥25. Obesity is one of the leading public health problems in the United States, contributing to significant morbidity, mortality, and public health cost. Obesity-related illnesses, including cardiovascular disease, stroke, and certain types of cancer are some of the leading…
Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder that develops after an exposure to a severe traumatic event. According to Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnostic criteria, a traumatic event is defined as exposure to actual or threatened death, serious injury, or sexual violence. Exposure to a traumatic event is very common; up to 90% of population has experienced a qualifying traumatic…
Introduction How did doctors become complicit in the worst opioid epidemic in US history, and why are they continuing to prescribe copious opioids despite increased national awareness of the dangers associated with these drugs? In other words, how did healers become dealers? To understand the origins, evolution, and persistence of this massive public health debacle, it is essential to understand that opioids never were the solution…
Introduction The use of intoxicating addictive substances by adolescents may lead to serious adverse cognitive, mental health, psychosocial, and medical consequences, as well as negatively impact normal adolescent brain development. Thus, substance use among adolescents is a major health concern. One of the most important tasks of adolescence is called “identity formation,” ideally leading to a healthy, happy, and productive adulthood. There are numerous aspects of…
There are a variety of behavioral treatments with established evidence for treating substance use disorders (SUDs). These include cognitive behavioral therapy (CBT)-based approaches, contingency management, motivational interventions, mindfulness-based treatments, and marital and family therapies. Additionally, self-help organizations/mutual help groups can play an integral role in a comprehensive recovery plan and can be a useful adjunct to evidence-based psychotherapies for SUDs. Each of these approaches will be…
Disclosure Statement Dr. Heinzerling has received research support and study medication, but no salary, from Alkermes, Medicinova, and Denovo pharmaceuticals. Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” and chronic pain is defined as “pain that persists beyond normal tissue healing time, which is assumed to be 3 months.” An…
Acknowledgments Supported by NIH grants DA041226, AA026006, and AA023669 (LR) and T32 DA007272 (AV). Introduction Alcohol use disorder (AUD) is a chronic, relapsing condition, characterized by continued use despite a host of harmful medical, psychological, and social consequences. AUD and its associated consequences remain significant public health problems, as alcohol misuse was deemed the fifth largest risk factor for premature death and disability in 2010. Further,…
Disclosures Dr. Danovitch has no conflicts of interest to report. Dr. Gorelick receives royalties from UpToDate for articles about cannabis Introduction Cannabis is a flowering plant containing a class of lipophilic hydrocarbons called “cannabinoids.” The stem, leaves, and flowers from cannabis have been cultivated throughout history for therapeutic as well as intoxicating purposes. There are dozens of unique cannabinoid substances in cannabis, only several of which…
Introduction Definition and Epidemiology of Opioid Use Disorder . Opioid use disorder is a chronic, relapsing disease marked by loss of control over opioid use (e.g., heroin or prescription opioids such as oxycodone or hydrocodone) despite social, psychological, or medical consequences related to use. Per the Diagnostic and Statistical Manual-5 (DSM-5), additional clinical criteria for OUD may include cravings, failed role obligations, use in physically hazardous situations,…
Just for fun, check out the last five to ten years of “ 10 Breakthrough Technologies ” published in the MIT Technology Review. In most years, well over half of the discoveries in each list have clear relevance to health and health care or are communication, connectivity, and computational advances. If you allow yourself to imagine how some of these technological advances might be applied to…
Chapter Intro Our understanding of the neurobiological basis of substance use disorders (SUD) is limited, so are available treatment options. Patterns of substance use intersect with stress, appetite, sleep, anxiety and sex. These physiologic drives are regulated predominantly by endocrine pathways. As such, it makes sense to examine whether hormonal systems play a role in the initiation or maintenance of substance use disorders. Exploring and exploiting…
Introduction Background of Electronic Nicotine Delivery Systems Invented in 2003 by Chinese pharmacist Hon Lik, electronic nicotine delivery systems (ENDS), also referred to as electronic cigarettes (e-cigarettes or ECIGS), constituted a 10 billion US dollar global market in 2015. Most e-cigarette sales occur online, consisting of extensive advertisement and multiple platforms for social communities surrounding e-cigarettes, which further facilitates the putative expansion of e-cigarette use by…
Introduction The addiction epidemic in the United States has now reached crisis proportions. It is no longer a topic confined to healthcare professionals and is now receiving considerable attention by the press, media, and politicians. Recent data shows widespread use in adolescents and teens. With substance use disorder (SUD) rates rising, there is an urgent need for new and innovative treatment modalities. The concept of using…
Overview Substance use disorders are characterized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”. The diagnostic criteria are further categorized into the symptom clusters of impaired control over use, compulsivity, harmful consequences, and the physiological symptoms of tolerance and withdrawal. These symptoms may…