The Medical clinics of North America
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Methods to prevent substance use disorders (SUDs) act on the individual risk factors for addiction. Most adults with SUD initiated substance use during their teenage years, so preventive interventions during adolescence are critical. ⋯ Pediatric primary care is an ideal place to incorporate preventive counseling and screening for substance use. Evidence-based technologic interventions for primary, secondary, and tertiary prevention are needed.
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Benzodiazepine and related sedative use has been increasing. There has been a growing number of unregulated novel psychoactive substances, including designer benzodiazepines. ⋯ The quality of evidence on medications for benzodiazepine discontinuation is overall low, whereas cognitive behavioral therapy has shown the most benefit in terms of behavioral treatments. Benzodiazepines may also have significant adverse effects, increasing the risk of overdose and death.
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Med. Clin. North Am. · Jan 2022
Review Historical ArticleWhat Is Addiction? History, Terminology, and Core Concepts.
Medicine's acceptance of addiction as a medical concept has waxed and waned over time. Addiction, as a disease, fits with modern disease definitions and scientific advances in elucidating the interactions between neurobiology and environment. ⋯ Addiction aligns with diagnostic categories of substance use disorders that do not rely on tolerance and withdrawal as defining characteristics. Shifts in social and political views of addiction continue to propel and mirror changes in addiction treatment approaches and terminology within the medical community.
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Tobacco use disorder is highly prevalent; more than a billion individuals use tobacco worldwide. Popular views on the addictive potential of tobacco often underestimate the complex neural adaptations that underpin continued use. Although sometimes trivialized as a minor substance, effects of nicotine on behavior lead to profound morbidity over a lifetime of exposure. ⋯ Proactive treatment strategies focus on pharmacotherapeutic interventions. Innovations on the horizon hold promise to help clinicians address this problem in a phenotypically tailored manner. Efforts are needed to prevent tobacco use for future generations.