Academic journal article Alcohol Research

Treatment of Co-Occurring Alcohol and Other Drug Use Disorders

Academic journal article Alcohol Research

Treatment of Co-Occurring Alcohol and Other Drug Use Disorders

Article excerpt

Drug use disorders (DUDs) frequently co-occur with alcohol use disorders, affecting approximately 1.1 percent of the U.S. population. Compared with alcohol use disorders or DUDs alone, co-occurring disorders are associated with a greater severity of substance dependence; co-occurring psychiatric disorders also are common in this patient population. Many effective medications and behavioral treatments are available to treat alcohol dependence and drug dependence when these occur independent of one another. There is a paucity of research, however, specifically focused on the treatment of persons with co-occurring alcohol and other DUDs (AODUDs). The evidence to date on treating this patient population suggests that combining some of the behavioral and pharmacologic treatments that are effective in treating either drug or alcohol use disorders alone may be useful in the AODUD population as well. KEY WORDS: Alcohol and other drug use disorder (AODUD); dual addiction; co-morbid AOD dependence; treatment methods; psychosocial treatment method; behavior therapy; pharmacotherapy; combined treatment; literature review

An estimated 1.1 perdrAcent of the U.S. population has an alcohol use disorder with a co-occurring ug use disorder (DUD) (Stinson et al. 2005). This type of co-morbidity is sometimes referred to as homotypic comorbidity or dual dependence (Stinson et al. 2005). To be consistent with the theme of this issue, this article refers to people with this combination of disorders as having alcohol and other drug (AOD) use disorders (AODUDs). Many people with alcohol use disorders use other substances at some point in their lives. This article focuses on the following AOD combinations: alcohol and cocaine, alcohol and cannabis, opioids and cocaine, and alcohol and cocaine with methadone maintenance. The drug that most commonly is com-bined with AODs is nicotine, which, because it was thoroughly discussed in a recent issue of Alcohol Research & Health (Volume 29, Number 3), is not discussed here.

After a brief discussion of assessment, placement, and treatment matching, this article reviews the literature on evidence-based pharmacologic and behavioral treatment strategies for AOD dependence. It also presents evidence for using specific treatments for AODUDs and provides recom-mendations on how to implement these treatments.

ASSESSMENT, PLACEMENT, AND TREATMENT MATCHING

In general, patients with AODUDs have a greater severity of substance dependence than patients with only an alcohol use disorder or a DUD. People with AODUDs are at least as likely to have co-occurring psychiatric disorders as those who have only DUDs and are more likely to have such disorders than those with only alcohol use disorders (Stinson et al. 2005). In addition, peo-ple with AODUDs are more likely than those with either drug or alcohol use disorders alone to seek treatment (Stinson et al. 2005). Thus, patients with AODUDs are perhaps best evaluated for treatment planning by a practitioner with specialized expertise in addictive disorders. Although many factors dictate the initial placementand treatment of the AODUD patient (e.g., co-occurring pregnancy or the need for medical detoxification), general guidelines are available. The American Society of Addiction Medicine (ASAM) has published guidelines for placement and treatment matching (ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders 2001). The American Psychiatric Association (APA) also has published guidelines for the treatment of substance use disorders (SUDs), which cover the issue of placement into various treatment settings (Kleber et al. 2007). Treatment that integrates AODUDs and psychiatric care probably is optimal for most AODUD patients, particularly those with greater severity of psychiatric co-morbidity (Drake et al. 2004). Effective integrated, dual-diagnosis programs emphasize the combination of multiple treatment modalities delivered in a format that acknowledges the limitations and nature of co-occurring psychiatric illness and is delivered by a staff skilled in the treatment of both addictive and psychiatric disorders. …

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