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This recent article investigated whether heroin addicts could make the transition from heroin to buprenorphine at home, rather than in the office. Office-based inductions have been preached as the standard of care. But in this study, most addicts did fine. I've been doing this way for some time now, without a problem.  MW   Home- versus office-based buprenorphine inductions for opioid-dependent patients. Sohler N.L., Li X., Kunins H.V. et al. Journal of Substance Abuse Treatment: 2010, 38, p. 153–159. Unable to obtain a copy by clicking title above? Try asking the author for a reprint (normally free of charge) by adapting this  prepared e-mail  or by writing to Dr Sohler at  nsohler@sci.ccny.cuny.edu.  You could also try this  alternative  source. Is is safe and will heroin-dependent patients complete the process and stay in treatment if they start buprenorphine maintenance at home rather than being observed and doses adjusted at the clinic? This...

Many people assume that the time between Thansksgiving and the winter solstice holidays are the most difficult time of the year for people in  recovery. Temptations are harder to avoid, what with office and holiday parties, family gatherings, and so forth. Many people with alcohol dependence come from families with many heavy drinkers, so alcohol may be flowing freely, and there may be others who are intoxicated. (Ever notice how boring and obnoxious intoxicated people can be if you're not intoxicated yourself?) So cue-induced craving is certainly an issue, whether your cues are visual, smells, other being surrounded by others who are drinking. How can someone protect themselves, what are the best strategies? Another major trigger for many are negative or painful feelings. The constant drumbeat and ceaseless streaming of happy families enjoying their time together is very different from what most of us experience. Especially in early recovery, loneliness is common, and made so much...

Here's the abstract from a new study that used random assignment in prison (a nearly impossible task in itself) and found that trauma-informed, gender-specific care served female inmates better. Not very surprising but the authors are to be commended for their methodological rigor. Even more impressive, though was a whopping 67% reduction in reincarceration within 12 months after parole. Wow! Read more about it here. MW  A randomized experimental study of gender-responsive substance abuse treatment for women in prison Nena Messina , Ph.D. ,  Christine E. Grella , Ph.D. ,  Jerry Cartier , M.A. ,  Stephanie Torres , M.S. UCLA Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA Received 1 July 2009 ; received in revised form 26 August 2009 ; accepted 20 September 2009. published online 16 December 2009. Abstract Full Text PDF References Abstract  This experimental pilot study compared postrele...

I just got back from a meeting of the American Academy of Addiction Psychiatry, and one of the most striking things was the lack of anything new in the treatment of addiction. There was a lot of tweaks of existing modalities, both behavioral and pharmaceutical, but nothing groundbreaking. As a clinician, I encounter this every day. We have a handfull of psychotherapeutic and pharmaceutical treatments available, but it is no where near enough. Far too many patients respond modestly or not at all to available treatments of all kinds. Don't drink the Kool-Aid of 12-Step programs that tell you that their approach is 100% effective among those who truly want sobriety and work the program. It's simply not true, and most older AA'ers will admit that. There are very few treatments that even approach that level of efficacy. In most of medicine, we are simply slowing the rate of deterioration, if that. I believe that talking therapy approaches have reached the point where further ref...

In a recent article, Mariani and colleagues reported on a pilot study of a combination of mixed amphetamine salts (MAS; most commonly known as Adderall) and topiramate (Topamax) in the treatment of cocaine addiction. Their study appeared in the journal  Biological Psychiatry  (the reference is Mariani et al.,  Volume 72, Issue 11 , 1 December 2012, Pages 950–956.) In the study, subjects were randomized to receive either a combination of MAS and topiramate, an anticonvulsant used for epilepsy and migraine prophylaxis and which is also effective for treating alcohol dependence, or placebo. They found that the proportion of subjects able to achieve 3 consecutive weeks of abstinence from cocaine was significantly better over a 4-week period. The figure below, from the article, shows the difference between the two groups over the course of the study. By study end, 4/13 of subjects receiving the medication combination had complete 3 weeks of abstinence, compared to 0/11 of the ...