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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;9\\\/3\\\/11\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;9\\\/3\\\/11\u0022}],\u0022ac\u0022:{\u0022spmdc;9\\\/3\\\/11\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;9\\\/3\\\/11\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlcohol use disorders present a widespread and serious public health problem in the United States. The disparity between the prevalence of this disorder and the number of persons who receive treatment indicates a huge gap in terms of evidence-based care. Likewise, individuals with psychiatric illness, particularly those with severe disorders, have rates of smoking addiction that are 2 to 3 times higher than the general population. This article discusses advances in alcohol and tobacco dependence.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESmoking Cessation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESubstance-Related Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAdvances in Alcohol and Tobacco Dependence\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EAlcohol use disorders present a widespread and serious public health problem in the United States (US). Results of an epidemiological study that used DSM-IV criteria to examine the lifetime and 12-month prevalence of alcohol use disorders in the United States during 2001\u20132002 showed that 8.5% of adults had experienced alcohol use disorders in the prior 12 months (4.7% abuse, 3.8% dependence) and that 30.3% experienced alcohol use disorders during their lifetimes (17.8% abuse, 12.5% dependence). Only 24.1% of those with alcohol dependence were ever treated [Hasin DS et al. \u003Cem\u003EArch Gen Psychiatry\u003C\/em\u003E 2007]. The disparity between the prevalence of this disorder and the number of persons who receive treatment indicates a huge gap in terms of evidence-based care.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EHugh Myrick, MD, discussed the approach to treatment that is used at the Medical University of South Carolina, Charleston, SC, as well as several recent studies on the use of anticonvulsants in the treatment of alcoholism.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe majority of alcohol withdrawal treatment is now done on an outpatient basis, using decreasing doses of benzodiazepines over 4 to 7 days. As a class, the benzodiazepines are subject to abuse, however, and in addition, recent studies have shown that they may prime alcoholics to drink [Poulos \u0026amp; Zack. \u003Cem\u003EBehav Pharm\u003C\/em\u003E 2004]. Researchers have been studying anticonvulsants as an alternative to benzodiazepines for alcohol detoxification since the 1970s. Dr. Myrick presented data from 2 studies in which an anticonvulsant was compared with a benzodiazepine.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EResults from a double-blind, outpatient trial (n=136) that compared 5-day tapering doses of carbamazepine (600 to 800 mg\/day tapered to 200 mg\/day) with lorazepam (6 to 8 mg\/day tapered to 2 mg\/day) showed that both drugs were effective in decreasing the symptoms of alcohol withdrawal. However, carbamazepine was superior to lorazepam in preventing rebound withdrawal symptoms and reducing post treatment drinking, particularly for those with a history of \u22652 prior medicated detoxifications (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Malcolm R et al. \u003Cem\u003EJ Gen Int Med\u003C\/em\u003E 2002]. Results from another study that compared gabapentin with lorazepam showed similar efficacy between the 2 medications in reducing alcohol symptoms but significantly (p\u22650.05) lower odds of drinking in the low-dose gabapentin group versus lorazepam [Myrick H et al. \u003Cem\u003EAlcohol Clin Exp Res\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Drinks per Drinking Day: Day 6 to Day 12.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2335565\u0022 data-figure-caption=\u0022Drinks per Drinking Day: Day 6 to Day 12.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11565\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EDrinks per Drinking Day: Day 6 to Day 12.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EFour treatments are currently approved by the FDA to treat alcohol dependence: disulfiram (Antabuse\u003Csup\u003E\u00ae\u003C\/sup\u003E), naltrexone (ReVIa\u003Csup\u003E\u00ae\u003C\/sup\u003E), acamprosate (Campral\u003Csup\u003E\u00ae\u003C\/sup\u003E), and extended-release injectable naltrexone (Vivitrol\u003Csup\u003E\u00ae\u003C\/sup\u003E). As with many chronic diseases, adherence is an issue with alcoholism. Medication discontinuations are high, and 1 study of naltrexone has shown that \u223c50% of patients do not refill their prescription even once [Harris KM et al. \u003Cem\u003EPsychiatr Serv\u003C\/em\u003E 2004]. Nonadherent patients are more likely to have significantly more inpatient detoxification admissions, nonalcohol-specific hospital admissions, and nonalcohol-specific ER visits and no counseling participation [Stephenson et al. Am Acad Addiction Psychiatry 2006 Annual Meeting]. Once-monthly injections of extended-release naltrexone have been shown to prolong initial abstinence and reduce heavy drinking days in alcohol-dependent adults [Garbutt JC et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2005; O\u0027Malley SS et al. \u003Cem\u003EJ Clin Psychopharmacol\u003C\/em\u003E 2007] and may increase adherence with medication [Un H. Addiction Health Services Research 2008 Annual Meeting].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIndividuals with psychiatric illness, particularly those with severe disorders, have rates of smoking addiction that are 2 to 3 times higher than the general population [Morisano D et al. \u003Cem\u003ECan J Psychiatry\u003C\/em\u003E 2009]. They also have more difficulty quitting (success rates of \u223cone-third of the general population). Recent data show that tobacco smoking accounts for as much as 50% of the reduction in life expectancy that is seen in persons with psychiatric disorders, such as schizophrenia and bipolar disorder [Hennekens CH et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2005]. Tony P. George, MD, FRCPC, University of Toronto and The Centre for Addiction and Mental Health, Toronto, Ontario, Canada, discussed some of the approaches that can be used to assist these individuals with smoking cessation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EA number of barriers to effective treatment of nicotine dependence exist, some of which are particularly relevant to persons with psychiatric disorders, including the limited access to smoking cessation services for the mentally ill and the rarity of smoke-free living environments for these individuals. Further, a substantial proportion of the staff at mental health centers are current smokers themselves, and it has been shown that current smokers are less likely than those who have quit to refer patients for smoking cessation treatment [Weinberger et al. \u003Cem\u003EJ Addict Dis\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAlthough all smokers should be offered cessation therapy, the best candidates for pharmacotherapy are daily smokers (at least \u0026gt;10 cigarettes\/day) who show evidence for moderate to heavy levels of nicotine dependence (eg, Fagerstrom Test of Nicotine Dependence [FTND] score \u0026gt;5), are willing to comply with daily medication dosing, and accept basic cessation counseling during the medication trial. There are 3 classes of pharmacotherapy for tobacco dependence: nicotine replacement therapies (NRTs), the antidepressant bupropion (in the sustained release formulation), and the nicotinic partial agonist varenicline (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). Several new tobacco pharmacotherapies, such as corticotropin releasing factor (CRF) antagonists, glutamate modulating agents, monoamine oxidase inhibitors, \u03b3-aminobutyric acid (GABA-B) receptor agonists, and nicotine vaccines, are on the horizon.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Smoking Abstinence.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2335565\u0022 data-figure-caption=\u0022Smoking Abstinence.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/3\/11\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11567\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003ESmoking Abstinence.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EAs with many medical conditions, combination therapy for smoking cessation is now being evaluated in clinical studies. Dr. George presented the results of a 10-week, double-blind, placebo-controlled trial in which outpatients with schizophrenia who were also smokers were treated with either sustained-release bupropion 300 mg\/day plus a nicotine patch (21 mg\/24 h; n=29) or the patch alone (n=29). The primary endpoints were continuous smoking abstinence in the last 4 weeks of the trial and 7-day point prevalence abstinence 6 months after the target quit date. The results at the 7-day point prevalence endpoint were similar for both treatments; however, smokers who received the combination treatment were significantly (p\u0026lt;0.05) more likely to achieve continuous smoking abstinence (8\/29, 27.6%) than those who were treated with the patch alone (1\/29, 3.4%). Neither bupropion SR nor smoking abstinence significantly altered the positive or negative symptoms of schizophrenia. The combination was well tolerated in smokers with schizophrenia [George TP et al. \u003Cem\u003EBiol Psychiatry\u003C\/em\u003E 2008]. Several other studies on treating tobacco addiction in other psychiatric disorders (eg, major depression, posttraumatic stress disorder, and bipolar 1 disorder) are ongoing and hopefully will provide guidance on how to approach smoking cessation in this difficult-to-treat population.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EIn summary, Dr. George said psychiatrists need to identify cigarette smokers in their practice, assess motivation to quit, and either treat these patients or refer them for treatment.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/3\/11.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}