Livros: "Alcohol withdrawal"

1

DePetrillo, Paolo B. Alcohol withdrawal treatment manual. Glen Echo, MD: Focus Treatment Systems, 1999.

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2

Paula, Catherine. A psychological approach to alcohol withdrawal. Birmingham: University of Birmingham, 2000.

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3

Paula, Catherine. A psychological approach to alcohol withdrawal. Birmingham: University of Birmingham, 2000.

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4

Hunter, Barbara, Lynda Berends, Linda Jenner, Matthew Frei, Pauline Kenny, Amy Swan e Janette Mugavin. Alcohol and other drug withdrawal: Practice guidelines. Fitzroy, Victoria, Australia: Turning Point Alcohol & Drug Centre, 2012.

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5

Crome, Ilana Belle. The experiences of withdrawal and craving in alcohol and opiate dependence. Birmingham: University of Birmingham, 1995.

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6

Center for Substance Abuse Treatment (U.S.), ed. Detoxification from alcohol and other drugs. Rockville, MD (Rockwall II, 5600 Fishers Lane, Rockville 20857): U.S. Dept of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1995.

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7

CRAG/SCOTMEG Working Group on Mental Illness. The management of alcohol withdrawal and delirium tremens: A good practice statement : final report 30 June 1994. [Edinburgh]: Scottish Office, 1994.

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8

McGrane, Tracy. Alcohol Withdrawal. Editado por Matthew D. McEvoy e Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0093.

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This chapter, “Alcohol Withdrawal,” reviews the prevalence, presentation, pathophysiology, and anesthetic considerations for patients encountered at risk of alcohol withdrawal, as well as current intensive care unit practices caring for patients at risk of alcohol withdrawal to allow for improved perioperative crisis management. It reviews physiologic derangements in both acute and chronic alcoholism, and reviews the current evidence for prevention and treatment of alcohol withdrawal in the intensive care unit, including fixed-dose versus loading-dose versus symptom-based treatment using benzodiazepines, and the use of alcohol, barbiturates, propofol, beta blockers, and alpha-2 agonists as treatment choices. Also discussed are complications of alcohol withdrawal syndrome to recognize and considerations for treatment of pregnant women and elderly patients in alcohol withdrawal.

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9

Alcohol withdrawal syndrome. [Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, 1989.

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10

Bowden, Suzanne. Alcohol Withdrawal Pocketcard. Borm Bruckmeier Publishing LLC, 2006.

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11

Gross, Milton M. Alcohol Intoxication and Withdrawal - IIIb: Studies in Alcohol Dependence. Springer, 2012.

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12

Gross, Milton M. Alcohol Intoxication and Withdrawal I: Experimental Studies. Springer, 2012.

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13

Gross, Milton. Alcohol Intoxication and Withdrawal: Experimental Studies II. Springer, 2014.

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14

Keshav, Satish, e Palak Trivedi. Alcohol intoxication. Editado por Patrick Davey e David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0083.

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Alcohol intoxication occurs when the quantity of alcohol (ethanol) consumed exceeds one’s tolerance for the substance, with consequent impairment of the individual’s mental and physical functional status. Alcohol abuse is a broad term for general ill health (mental, social, and/or physical) resulting from the repetitive, compulsive, and uncontrolled consumption of alcoholic beverages. Manifestations of alcohol abuse include a failure to fulfil one’s responsibilities, resulting in loss of employment, personal relationships, or finances. Alcohol dependence is a condition which arises as a result of alcohol abuse and occurs when an individual continually uses alcohol despite significant areas of dysfunction, with evidence of physical dependence.Alcohol withdrawal syndrome is the set of symptoms and physical signs observed when an individual reduces or abruptly stops alcohol consumption after prolonged periods of excessive intake; it is largely due to the development of a ‘hyperexcitable’ central nervous system. Delirium tremens is the most severe form of alcohol withdrawal; it manifests as altered mental status, hallucinations, and sympathetic overdrive, which may progress to cardiovascular collapse if left untreated.

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15

Drug Overdoses and Alcohol Withdrawal: Prevalence, Trends and Prevention. Nova Science Publishers, Incorporated, 2015.

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16

Henri, Begleiter, e Kissin Benjamin 1917-, eds. The pharmacology of alcohol and alcohol dependence. New York: Oxford University Press, 1996.

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17

Wijdicks, Eelco F. M., e Sarah L. Clark. Drugs Used to Treat Withdrawal Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190684747.003.0018.

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This chapter covers the treatment of withdrawal syndromes associated with alcohol, opioids, stimulants, baclofen, and nicotine. The approach to refractory withdrawal delirium is discussed, as well as the management of serious withdrawal syndromes that are neurology-specific, such as baclofen withdrawal. Withdrawal syndromes are serious and may require extensive pharmacotherapy. The safety of the patient must be balanced against the risks and side effects of the medications administered to control the agitation. Prior alcoholism accounts for the overwhelming proportion of patients with withdrawal syndromes. The drugs used for treatment of alcohol withdrawal syndrome include benzodiazepines, dexmedetomidine, and propofol. The prevalence of opioid withdrawal is increasing.

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18

Lubelczyk, Rebecca. Detoxification or supervised withdrawal. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0017.

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Drugs or alcohol are used at the time of the offense by over half of all detainees, necessitating screening for both intoxication and risk of withdrawal from substances at intake. Intoxication and withdrawal can mimic signs and symptoms of an acute mental disorder or exacerbate an underlying chronic disease. One of the most difficult challenges a clinician may face is differentiating whether the presentation is due to a combination of intoxication/withdrawal and mental illness versus mental illness alone. Using substances while on psychiatric medications can alter the pharmacology, change the effectiveness, and exacerbate the side effects of medications, potentially causing lack of response, nonadherence, or dangerous physical effects. Substance use also puts the patient at risk for trauma and exposure to infections from risky behaviors while intoxicated. The clinician faces an imposing challenge in any attempt to accurately assess underlying psychopathology in the midst of acute detoxification. It is a generally accepted practice to reassess the patient’s psychotropic treatment needs once their detoxification is complete, but individual cases may require acute intervention based on the severity of the patient’s mental illness. This chapter attempts to educate the correctional clinician on the common presentations of intoxication and withdrawal syndromes of various substances. The similarities and distinctions of such syndromes with mental illnesses are discussed. Standardized medical management approaches to safeguard patient safety during supervised withdrawal are also presented. Following such a process allows the clinician to subsequently assess the patient’s true mental health and substance abuse treatment needs.

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19

Lubelczyk, Rebecca. Detoxification or supervised withdrawal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199360574.003.0017_update_001.

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Drugs or alcohol are used at the time of the offense by over half of all detainees, necessitating screening for both intoxication and risk of withdrawal from substances at intake. Intoxication and withdrawal can mimic signs and symptoms of an acute mental disorder or exacerbate an underlying chronic disease. One of the most difficult challenges a clinician may face is differentiating whether the presentation is due to a combination of intoxication/withdrawal and mental illness versus mental illness alone. Using substances while on psychiatric medications can alter the pharmacology, change the effectiveness, and exacerbate the side effects of medications, potentially causing lack of response, nonadherence, or dangerous physical effects. Substance use also puts the patient at risk for trauma and exposure to infections from risky behaviors while intoxicated. The clinician faces an imposing challenge in any attempt to accurately assess underlying psychopathology in the midst of acute detoxification. It is a generally accepted practice to reassess the patient’s psychotropic treatment needs once their detoxification is complete, but individual cases may require acute intervention based on the severity of the patient’s mental illness. This chapter attempts to educate the correctional clinician on the common presentations of intoxication and withdrawal syndromes of various substances. The similarities and distinctions of such syndromes with mental illnesses are discussed. Standardized medical management approaches to safeguard patient safety during supervised withdrawal are also presented. Following such a process allows the clinician to subsequently assess the patient’s true mental health and substance abuse treatment needs.

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20

Publications, ICON Health. Alcohol Withdrawal - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. ICON Health Publications, 2004.

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21

J, Porter Roger, e Richard H. Mattson. Alcohol and Seizures: Basic Mechanisms and Clinical Concepts. F.A. Davis Company, 1990.

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22

1942-, Porter Roger J., e International Symposium on Alcohol and Seizures (1988 : Washington, D.C.), eds. Alcohol and seizures: Basic mechanisms and clinical concepts. Philadelphia: Davis, 1990.

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23

A Review of the Genetics of Alcoholism and a Confirmatory Study of an Acute Alcohol Withdrawal Quantitative Trait Locus in Mice. Storming Media, 1999.

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24

Wiffen, Philip, Marc Mitchell, Melanie Snelling e Nicola Stoner. Therapy-related issues: miscellaneous. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199603640.003.0028.

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Introduction to critical care 592Delirium/acute confusional state 596Stress ulcer prophylaxis 598Motility stimulants 600Mechanical ventilation 602Vasoactive agents 604Renal replacement therapy 606Treatment of alcohol withdrawal 610Dealing with poisoning enquiries 614Drug desensitization 618Drug interference with laboratory tests 620...

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25

Valpey, Robin, e Amy Crawford-Faucher. Behavioral Health Emergencies (DRAFT). Editado por Raghavan Murugan e Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0016.

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Behavioral health emergencies typically involve agitation with autonomic instability. Many medical and psychiatric conditions can precipitate agitation that could necessitate rapid response interventions. Non-pharmacologic therapies can be useful to modulate agitation or delirium, but the mainstay of pharmacologic treatment is either antipsychotics or benzodiazepines, depending on the underlying problem. Psychosis and delirium generally respond better to antipsychotics, while mania, catatonia, toxidromes, withdrawal, and agitation from head injuries are more effectively treated with benzodiazepines. Prompt recognition of severe alcohol withdrawal can improve mortality; getting a history of other drug use, including “designer drugs” can help inform care. This chapter discusses the treatment of agitation, catatonia, medication-related disturbances, and intoxication and withdrawal during emergencies.

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26

Banerjee, Ashis, e Clara Oliver. Gastrointestinal emergencies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198786870.003.0013.

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This chapter covers the medical aspects of patients presenting to the emergency department with a gastrointestinal problem. It covers both upper and lower gastrointestinal bleeding, including the management and scoring systems available for risk stratification. This chapter also includes a section on diarrhoea and vomiting, as well as the management of individuals with inflammatory bowel disease. In addition to bowel-related pathology, another common presentation includes liver and alcohol-related pathology. This chapter summarizes the key aspects of liver failure. Included in this are the key investigation and indications for transplant, as well as the management of alcohol-related liver disease and alcohol withdrawal.

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27

Cooper, M. Lynne, Emmanuel Kuntsche, Ash Levitt, Lindsay L. Barber e Scott Wolf. Motivational Models of Substance Use. Editado por Kenneth J. Sher. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199381678.013.017.

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This chapter uses Cox and Klinger’s motivational model of alcohol use as a framework for reviewing research on motives for using alcohol, marijuana, and tobacco. Results of this review provide strong support for key premises underpinning this model in the alcohol literature, including that people drink alcohol to manage internal feeling states and to obtain valued social outcomes. Importantly, these motives may provide a final common pathway to alcohol use through which the influences of more distal variables are mediated. The research literature on motives for marijuana use revealed important similarities in the nature of motives underlying use and in the unique patterns of use and use-related consequences associated with specific motives. Research on tobacco use motives showed few similarities, with tobacco use being more habitual, automatic, and largely motivated by withdrawal cues, at least among more experienced and dependent users.

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28

Schulkin, Jay. Cravings and Addictions. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780198793694.003.0008.

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The allure of afflictions and appetites gone awry are endless in the modern era. They range from the endless junk food we eat, to the computer games that lock our children to distraction, compulsion, and fixation on a screen. A sense of compulsion pervades addiction. For both appetite and addiction, incentives are mediated by diverse information molecules, which include CRF and dopamine. Chapter 8 explains how CRF is tied both to the ingestion of diverse drugs and to withdrawal. This process, however, is little understood. Indeed, one of the most important discoveries in the addiction research field was that for all addictive drugs that have been tested, this dual phenomenon on ingestion and withdrawal has been expressed; this included cocaine, heroin, alcohol, and cannabis, for example. The brain is active in all stages of addiction (preoccupation/anticipation, binge/intoxication, withdrawal/negative affect, and psychic pain), and is differentially regulated.

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29

Information Path Functional and Informational Macrodynamics. Nova Science Publishers, Incorporated, 2009.

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30

Swift, Robert M. Pharmacotherapy of Substance Use, Craving, and Acute Abstinence Syndromes. Editado por Kenneth J. Sher. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199381708.013.12.

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Advances in the understanding of the neurobiological basis of addiction have led to a better understanding of the causes of drug and alcohol dependence, as well as to new alternatives in the treatment of these disorders. By addressing some of the underlying neurobiological changes that cause and maintain drug and alcohol dependence, pharmacotherapies can provide an important adjunctive treatment for alcohol- and drug-dependent and behaviorally addicted patients. During detoxification, pharmacotherapies can reduce the severity of withdrawal. After detoxification, pharmacotherapies can be useful as an adjunct to psychosocial treatments to help maintain abstinence or reduced addictive behaviors by reducing craving, reducing the rewarding effects of drugs, and improving the allostasis that accompanies abstinence. This chapter describes the neurobiology of drugs and alcohol, how chronic use leads to brain adaptations that result in addiction, and the actions of medications used to treat addictive disorders.

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31

McCracken, Lindsay M., Mandy L. McCracken e R. Adron Harris. Mechanisms of Action of Different Drugs of Abuse. Editado por Kenneth J. Sher. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199381678.013.010.

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Drugs of abuse represent a spectrum of chemically diverse compounds that are used via various routes of drug administration depending on the drug and its preparation. Although the exact molecular mechanisms by which these agents act to produce their intoxicating effects are not completely understood, many drugs of abuse are known to bind to specific neuronal membrane proteins that produce effects on cellular signaling and ultimately on behavior. With repeated administration of a drug, individuals often develop tolerance, and discontinuation of drug use following chronic administration typically results in withdrawal symptoms. This chapter describes the mechanism of action for the following classes of drugs of abuse: alcohol, cannabinoids, hallucinogens, inhalants, nicotine, opioids, sedative hypnotics, and stimulants. In addition, mechanisms of tolerance and withdrawal are discussed.

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32

Sullivan, Maria A., e Frances R. Levin. Introduction. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0001.

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Alcohol and substance-use disorders in late life have been under-studied. Alcohol and prescription drugs are frequently abused by older Americans, yet addictive disorders are often difficult to identify in this population because of screening instruments adapted to younger adults, stigma and shame that limit help-seeking in older adults, and co-occurring medical and psychiatric conditions that mimic or mask both acute effects and withdrawal syndromes associated with alcohol or substance-use disorders. We will review the evidence for the effectiveness of motivational brief interventions in this population, the need to modify certain pharmacotherapies, including standard detoxification regimens, as well as how to develop age-specific treatment services which tailor the content and pace of presentation toward older adults. Older patients can demonstrate equally or more successful outcomes than younger individuals. This text is intended as a practical handbook to enhance clinical skills in identifying and treating addiction in older adults.

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Cavanna, Andrea E. Clonazepam and clobazam. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0004.

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Clonazepam and clobazam are first-generation antiepileptic drugs characterized by few antiepileptic indications, with good interaction profile in polytherapy. Both clonazepam and clobazam are benzodiazepines with an acceptable behavioural tolerability profile and a good range of psychiatric uses (especially anxiety disorders, alcohol withdrawal, insomnia). Clobazam has an indication for short-term relief (2–4 weeks) of acute anxiety in patients who have not responded to other drugs, with or without insomnia, and without uncontrolled clinical depression. As with all benzodiazepines, caution should be used in consideration of the potential for tolerance and addiction, as well as the risks related to respiratory depression.

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Cavanna, Andrea E. Gabapentin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0006.

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Gabapentin is a second-generation antiepileptic drug characterized by few antiepileptic indications, with very good interaction profile in polytherapy. The therapeutic indications of gabapentin for the treatment of epileptic seizures have been largely overshadowed by its widespread use for the treatment of neuropathic pain (especially post-herpetic neuralgia, diabetic neuropathy, and pain caused by a spinal cord injury). Gabapentin has a good behavioural tolerability profile and a good range of psychiatric uses (unlicensed indications for anxiety disorders and alcohol withdrawal symptoms). Despite the widespread use of gabapentin for behavioural conditions, its potential usefulness as adjunctive treatment of bipolar affective disorder is still controversial.

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Cavanna, Andrea E. Zonisamide. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0016.

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Zonisamide is a second-generation antiepileptic drug characterized by a few antiepileptic indications, with an acceptable interaction profile in polytherapy. Zonisamide has an acceptable tolerability profile in patients with epilepsy, with depression, irritability, agitation and psychosis as the most commonly reported psychiatric adverse effects. Zonisamide has no approved indications or clinical uses in psychiatry, as initial findings from uncontrolled studies suggesting effectiveness in the treatment of patients with bipolar disorder did not find confirmation. There is preliminary evidence for possible usefulness of zonisamide in the treatment of patients with obesity and psychotropic-associated weight gain, as well as alcohol dependence and withdrawal.

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36

Karen, Bellenir, ed. Alcoholism sourcebook: Basic consumer health information about the physical and mental consequences of alcohol abuse, including liver disease, pancreatitis, Wernicke-Korsakoff syndrome (alcoholic dementia), fetal alcohol syndrome, heart disease, kidney disorders, gastrointestinal problems, and immune system compromise, and featuring facts about addiction, detoxification, alcohol withdrawal, recovery, and the maintenance of sobriety, along with a glossary and directories of resources for further help and information. Detroit: Omnigraphics, 2000.

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37

Nutt, David J., e Liam J. Nestor. What is addiction? Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198797746.003.0001.

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Substance addiction is defined as a chronic relapsing disorder characterized by (1) compulsion to seek and take a substance, (2) loss of control in limiting substance intake, and (3) the emergence of a negative emotional state (e.g. dysphoria, anxiety, irritability) reflecting a motivational withdrawal syndrome when access to the substance is prevented. Importantly, the occasional but limited use of addictive substances is clinically distinct from escalated substance use, loss of control over substance intake, and the emergence of chronic compulsive substance-seeking that characterizes addiction. Importantly, substance addiction (including alcohol) is a manifestation of the long-term pharmacological actions substances have on receptor mechanisms in brain networks that govern cognitive and psychological processes that have evolved for human survival.

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38

Rastegar, Darius, e Michael I. Fingerhood, eds. ASAM Handbook of Addiction Medicine. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780197506172.001.0001.

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This book is a concise, evidence-based guide to the treatment of individuals with substance use disorders. It is an update to the 2015 edition and is targeted to nonspecialist clinicians who want to better care for their patients with substance use disorders. It begins with chapters on screening and brief intervention and an overview of treatment. This is followed by substance-specific chapters covering the following topics: alcohol, sedatives, opioids, nicotine, stimulants, hallucinogens, cannabinoids, inhalants, anabolic steroids, and prescription drugs. Substance-specific chapters cover pharmacology, acute effects and intoxication, withdrawal, medical complications, and treatment. The handbook concludes with chapters on the medical care of patients with substance use disorders, psychiatric co-occurring disorders, special populations, and ethical/legal considerations. Chapters include practical tools and treatment protocols that can be used in outpatient and inpatient settings. The book contains numerous references, many of which are annotated.

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Sprigings, David. Delirium (acute confusional state). Editado por Patrick Davey e David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0041.

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Delirium is a functional brain disorder characterized by disturbances of consciousness, attention, and cognition. The term ‘acute confusional state’ is often used synonymously with ‘delirium’. Delirium may be associated with a range of associated clinical features including increased or decreased psychomotor activity (hyperactive and hypoactive variants), hallucinations and delusions, and efferent sympathetic hyperactivity. Delirium with pronounced psychomotor and sympathetic hyperactivity is more often seen in younger patients with alcohol or substance intoxication/withdrawal (delirium tremens), but no cause is specific to a clinical subtype. Delirium is distinguished from dementia (with which it may coexist, as dementia is a major risk factor for delirium) by its speed of onset (over hours or days) and reversibility with correction of the underlying cause. In some patients, however, delirium may be followed by long-term cognitive impairment, suggesting that the pathophysiology of delirium overlaps with that of dementia.

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Bleck, Thomas P. Pathophysiology and causes of seizures. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0231.

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Seizures result from imbalances between excitation and inhibition, and between neuronal synchrony and dyssynchrony. Current models implicate the cerebral cortex in the genesis of seizures, although thalamic mechanisms (particularly the thalamic reticular formation) are involved in the synchronization of cortical neurons. Often, the precipitants of a seizure in the critical care setting are pharmacological. Several mechanisms linked to critical illness can lead to seizures. Failure to remove glutamate and potassium from the extracellular space, functions performed predominantly by astrocytes, occurs in trauma, hypoxia, ischaemia, and hypoglycaemia. Loss of normal inhibition occurs during withdrawal from alcohol and other hypnosedative agents, or in the presence of GABA. Conditions such as cerebral trauma, haemorrhages, abscesses, and neoplasms all produce physical distortions of the adjacent neurons, astrocytes, and the extracellular space. Deposition of iron in the cortex from the breakdown of haemoglobin appears particularly epileptogenic. Although acute metabolic disturbances can commonly produce seizures in critically-ill patients, an underlying and potentially treatable structural lesion must always be considered and excluded.

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Linzer, Shoshana, Adina Chesir, Tal Ginsburg e Olivia Varas. Stressful Life Events. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190260859.003.0005.

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Stressful life events often occur during the week or month preceding suicide and may aid both the formation of the suicidal narrative and the triggering of the suicide crisis syndrome. This chapter examines the stressors that have been linked to imminent suicidal behavior. The chapter has five sections. The work and career section describes imminent risk associated with economic hardship, business/work failures, and home loss. The relationship conflict section discusses suicide risks stemming from romantic rejection, intimate relationship and family conflicts, as well as abuse, neglect, and bullying. The serious medical illness section discusses suicide risks associated with diagnosis and chronicity of being critically ill. The serious mental illness section focuses on imminent risk associated with recent diagnosis, acuity and hospitalization for mental illness, as well the risks following recent failed suicide attempts. The recent substance misuse section assesses imminent risk associated with chronic alcohol/drug use, acute intoxication, and withdrawal.

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42

Wakeman, Sarah E., e Josiah D. Rich. Pharmacotherapy for substance use disorders within correctional facilities. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0046.

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Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.

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43

Wakeman, Sarah E., e Josiah D. Rich. Pharmacotherapy for substance use disorders within correctional facilities. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199360574.003.0046_update_001.

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Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.

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44

Junkin, Ross, e Elizabeth M. McGrady. Substance abuse. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0051.

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Substance abuse in pregnancy is a cause of maternal and neonatal morbidity and mortality. It can lead to a wide range of health, social, and psychological problems. Many of these mothers are young, single, socially deprived, and often present late for antenatal care. The prevalence is unclear as substance abuse is often concealed, but it is most common in young adults, and may be around 4% in the United Kingdom and 6% in the United States. It is estimated that 200,000–300,000 children living in England and Wales have one or both parents with a drug problem. Patterns and prevalence of substance abuse vary between and within countries, but polysubstance abuse is common. Obstetric anaesthetists may be involved in care of mothers who have known or covert substance abuse. Common problems include poor nutrition, dentition, difficult intravenous access, immunosuppression, and altered drug metabolism. Use of some illicit drugs can cause obstetric complications, and others can mimic serious issues such as pre-eclampsia. The incidence of emergency caesarean delivery is higher. Neonates tend to be premature, small for gestational age, at risk of withdrawal, and have ongoing health issues throughout life. Healthcare workers should enquire about tobacco, alcohol, and illicit drug use early in pregnancy as advice and support may motivate women to alter their lifestyle. The impact of tobacco, caffeine, alcohol, marijuana, solvents, opioids, cocaine, and amphetamine use on the mother and fetus, and the implications for the obstetric anaesthetist, are presented.

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Stacey, Victoria. Gastroenterology. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199592777.003.0013.

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Acute gastrointestinal bleeding - Acute upper gastrointestinal bleeding - Acute lower gastrointestinal bleeding - Vomiting - Diarrhoea - Inflammatory bowel disease (IBD) - Liver failure - Alcoholic liver disease/withdrawal syndromes - SAQs

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Modir, Shahla, e George Munoz, eds. Integrative Addiction and Recovery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190275334.001.0001.

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Integrative Addiction and Recovery is a book discussing the epidemic of addiction that is consuming our friends, family, and community nationwide. In 2016, there were 64,000 drug overdoses, and addiction became the top cause of accidental death in America in 2015. We are in a crisis and in need of a robust and integrated solution. We begin with the definition of addiction, neurobiology of addiction, and the epidemiology of varying substances of abuse and treatment guidelines. Section II reviews different types of addiction such as food, alcohol, sedative-hypnotics, cannabis, stimulants (such as cocaine and methamphetamine), opiates (including prescription and illicit opiates), and tobacco, and evidence-based approaches for their treatment using psychotherapy, pharmacotherapy, as well as holistic treatments including acupuncture, nutraceuticals, exercise, yoga, and meditation. We also have chapters on behavioral addictions and hallucinogens. Section III reviews co-occurring disorders and their evidence-based integrative treatment and also overviews the holistic therapeutic techniques such as acupuncture and TCM, Ayurveda, homeopathy, nutrition, nutraceuticals, art and aroma therapy, and equine therapy as tools for recovery. We have unique chapters on shamanism and ibogaine, as well as spirituality and group support (12 steps included). The final section deals with challenges facing recovery such as trauma, acute/chronic pain, and post acute withdrawal. Integrative Addiction and Recovery is an innovative and progressive textbook, navigating this complex disease with the most comprehensive approach.

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