What We Can Learn about Addiction

By London, Robert T. | Clinical Psychiatry News, May 2005 | Go to article overview

What We Can Learn about Addiction


London, Robert T., Clinical Psychiatry News


Recently I attended a continuing medical education program at Columbia University's College of Physicians and Surgeons.

The program focused on the use of the partial opioid agonist buprenorphine for treating opioid dependence in an office practice. Our focus was on a formulation called Suboxone, which combines buprenorphine and naloxone. Suboxone is the preferred formulation of buprenorphine for maintenance treatment.

My special interest in the treatment of addiction has focused on tobacco smoking, which I believe is our greatest health hazard ("A Twist on Dual Diagnosis," CLINICAL PSYCHIATRY NEWS, January 2005, p. 30). So I was fascinated to learn about some of the progress we have made in treating opioid dependence.

The use of medication for addiction treatment is not new. For example, disulfiram (Antabuse), bupropion (Wellbutrin, Zyban), nicotine patches, and nicotine gum all have their place in addiction medicine.

The use of methadone--the first recognized chemical treatment for opioid addiction and dependence in the United States--began in the early 1960s.

Over the past 40 years or so, the concept of methadone maintenance has been controversial. Many people believe that "drug free" is the only way to treat addiction. That notion holds merit, and I'm certain that many people who are on maintenance programs would share that view.

But according to Eric D. Collins, M.D., a psychiatrist at Columbia University and one of the faculty members teaching this program, "When a patient regularly demonstrates that opioid dependence cannot be controlled through abstinence and that continued use presents a high risk of disease transmission, institutionalization, incarceration, and/or death, it's time to work within medical boundaries to treat opioid addiction in the best way we can."

This rationale supports the use of maintenance treatment with methadone--and now, to add another alternative in certain circumstances, buprenorphine. Because the use of buprenorphine is sufficiently complicated and the drug is prone to diversion, an 8-hour course and a Drug Enforcement Administration certificate is necessary to treat with buprenorphine in office practice.

Dr. Collins, a strong believer in the utility of buprenorphine for opioid dependence, sees this treatment not as a replacement for methadone, but as a parallel treatment for certain levels of opioid addiction. He points out that buprenorphine transitions patients from their illicit opioid use to buprenorphine. The program accepts people only after careful psychiatric/psychological evaluation of opioid use.

Furthermore, a personality inventory is taken, support systems are evaluated, and counseling or psychotherapy is offered for patients entering a buprenorphine maintenance program. Dr. Collins and clinical psychologist Margaret Rombone, Ph.D., work diligently to take psychiatric and psychological aspects of the people in the program as seriously as the actual use of medication in the program. The early stage--especially the first week--of buprenorphine treatment generally requires more intensive treatment. After that, the process usually goes smoothly, as long as relapse doesn't occur. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

What We Can Learn about Addiction
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.