TRIPASS XR تري باس

 

CONTRAINDICATIONS, WARNINGS, AND INTERACTIONS

Topiramate is contraindicated in those hypersensitive to the drug. Topiramate should

be used with caution in those who have a history of urolithiasis, paresthesias,

secondary angle closure glaucoma, renal or hepatic impairment, and conditions or

therapies that predispose to acidosis (e.g., renal disease, severe respiratory

disorders, status epilepticus, diarrhea, surgery, ketogenic diet, or drugs). Monitoring

for hyperchloremic non–ionic-gap metabolic acidosis is essential, and therefore

baseline chemistry (e.g., HCO3

− and pH) should be assessed and monitored regularly

thereafter. Metabolic acidosis can cause symptoms such as tiredness and loss of

appetite, or more serious conditions including arrhythmia or coma. Topiramate has

been found to be teratogenic in animal studies and is a pregnancy category C

medication.

264

Concomitant use of oral contraceptives, phenytoin, carbamazepine, and valproic

acid has been found to interact with topiramate.

220 Coadministration of another

carbonic anhydrase inhibitor, such as acetazolamide, may increase the possibility of

renal stone formation and should be avoided.

COMORBIDITIES IN ALCOHOL USE DISORDER

It is quite common for patients who are involved in harmful drinking to have

comorbid medical issues. Alcohol has significant drug interactions with many

medications (Table 90-8). Clinicians must also consider the potential for comorbid

psychiatric disorders, (also known as dual diagnosis, e.g., depression, bipolar

disorder, or schizophrenia) combined with a substance use disorders. Tobacco and

caffeine dependence are common.

265

Increased comorbid conditions lead to a poorer

treatment prognosis for both medical and psychiatric conditions.

p. 1901

p. 1902

Table 90-8

Ethanol–Drug Interactions

Acetaminophen Chronic excessive alcohol consumption increases susceptibility to acetaminophen-induced

hepatotoxicity. Acute intoxication theoretically protects against acetaminophen toxicity

because less hepatotoxic metabolite is generated.

Anticoagulants (oral) Chronic ethanol consumption induces hepatic metabolism of warfarin, decreasing

hypoprothrombinemic effect. Very large acute ethanol doses (>3 drinks/day) may impair

the metabolism of warfarin and increase hypothrombinemic effect. Vitamin K-dependent

clotting factors may be reduced in alcoholics with liver disease, also affecting coagulation.

Antidepressants Enhanced sedative effects of alcohol and psychomotor impairment are possible. Acute

ethanol impairs metabolism. Fluoxetine, paroxetine, fluvoxamine, and probably other

serotonin reuptake inhibitors (SSRIs) do not interfere with psychomotor or subjective

effects of ethanol.

Ascorbic acid Ascorbic acid increases ethanol clearance and serum triglyceride levels and improves

motor coordination and color discrimination after ethanol consumption. Barbiturates Phenobarbital decreases blood ethanol concentration; acute intoxication inhibits

pentobarbital metabolism; chronic intoxication enhances hepatic pentobarbital metabolism.

Benzodiazepines Psychomotor impairment increases with the combination.

Bromocriptine Ethanol increases gastrointestinalside effects of bromocriptine.

Caffeine Caffeine has no effect on ethanol-induced psychomotor impairment.

Calcium-channel

blockers

Verapamil inhibits ethanol metabolism and increases intoxication.

Cephalosporin

antibiotics

Ethanol produces flushing, nausea, headaches, tachycardia, and hypotension.

Cephalosporin antibiotics that have an ethyl tetrazole thiolside chain produce this

disulfiram-like reaction (e.g., cefoperazone, cefamandole, cefotetan).

Chloral hydrate Elevation of plasma trichloroethanol (a chloral hydrate metabolite) and blood ethanol may

occur. Combined central nervous system (CNS) depression. Vasodilation, tachycardia,

headache.

Chloroform Ethanol increases chloroform hepatotoxicity.

Doxycycline Chronic consumption of ethanol induces hepatic metabolism of doxycycline and may

lower serum concentration of the antibiotic.

Erythromycin Ethanol may interfere with absorption of the ethylsuccinate salt. Effects on other

formulations are unknown.

Furazolidone When ethanol is ingested, nausea, flushing, light-headedness, and dyspnea may occur (i.e.,

a disulfiram-like reaction).

H2

antagonists Cimetidine potentiates ethanol effects. Increases peak plasma ethanol concentrations and

area under the plasma ethanol concentration–time curve. CNS toxicity from increased

cimetidine serum concentration. Nizatidine and ranitidine may also increase blood alcohol

levels (BALs) slightly by inhibiting gastric alcohol dehydrogenase. Famotidine does not

affect BALs.

Isoniazid Consumption of ethanol with isoniazid increases risk of hepatotoxicity. Tyraminecontaining alcoholic beverages may cause hypertensive reaction.

Ketoconazole and

metronidazole

When ethanol is ingested, nausea, flushing, light-headedness, and dyspnea may occur (i.e.,

a disulfiram-like reaction may occur with metronidazole). A sunburn-like rash has been

reported with ethanol consumption and ketoconazole. A similar reaction may occur with

itraconazole, although no reports exist.

Meprobamate Synergistic CNS depression may occur.

Metoclopramide Enhances sedative effects of ethanol.

Monoamine oxidase

inhibitors

Tyramine-containing alcoholic beverages (e.g., wines, beer) may cause a hypertensive

crisis. Pargyline may inhibit aldehyde dehydrogenase and cause a disulfiram-like

interaction with ethanol.

Narcotic analgesics Volume of distribution of intravenous meperidine increases with increasing ethanol

consumption. Clinicalsignificance unknown. Potential for enhanced CNS depression.

Oral hypoglycemic

agents

Chlorpropamide, tolbutamide, and tolazamide may cause flushing, light-headedness,

nausea, and dyspnea if alcohol is ingested (i.e., a disulfiram-like reaction).

Paraldehyde Possible metabolic acidosis may occur.

Phenothiazines Potentiates psychomotor effects of ethanol.

Quinacrine Possibly inhibits acetaldehyde oxidation.

Salicylates Increases gastric bleeding associated with aspirin; may increase chance of gastrointestinal

hemorrhage.

Tetrachloroethylene Combined CNS depression may occur.

Trichloroethylene Flushing, lacrimation, blurred vision, and tachypnea may occur when patients exposed to

trichloroethylene drink alcohol.

Adapted from Ciraulo D, Shader RI, Greenblatt DJ, Creelman WL. Drug Interactions in Psychiatry. 3rd ed.

Philadelphia, PA: Lippincott Williams & Wilkins; 2006, with permission.

Principles for the optimal treatment of patients with a dual diagnosis include the

following: (a) flexibility (e.g., although the goal of treatment may be abstinence, for

some patents, movement in the right direction is just as important to keep the person

engaged in treatment); (b) repetition (e.g., a constant refocusing of attention for

avoiding alcohol and for confronting their psychiatric symptoms is a priority); and

(c) counseling (e.g., matching patients to the appropriate intervention). These factors

are all fundamental to long-lasting treatment success. Medications, when appropriate

(e.g., early and vigorous drug intervention with nonaddictive medications), may also

help the patient stay in treatment; however, every effort must be made to use

medications that do not induce euphoria or cause dependence, and are effective and

safe even during relapse.

2,3

Patients with both drug use and psychiatric disorders constitute a substantial and

challenging subpopulation. Treating the alcohol use disorder alone predicts a poorer

outcome for other disorders including early relapse. Early and aggressive treatment

for each condition should be implemented. Furthermore, care must be taken to ensure

that the medications prescribed are safe if combined with alcohol.

3

ACKNOWLEDGMENT

The author acknowledges the authors for their contributions to the following chapters

in previous versions of the textbook: Wendy O. Zizzo and Paolo V. Zizzo for their

chapter on Drug Abuse and George A. Kenna for his chapter on Alcohol Use

Disorders.

KEY REFERENCES AND WEBSITES

A full list of references for this chapter can be found at

http://thepoint.lww.com/AT11e. Below are the key references and website for this

chapter, with the corresponding reference number in this chapter found in parentheses

after the reference.

Key References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed.

Washington, DC: American Psychiatric Publishing; 2013. (1)

Perry EC. Inpatient management of acute alcohol withdrawalsyndrome. CNS Drugs. 2014;28:401–410. (168)

Lingford-Hughes AR, et al. BAP updated guidelines: evidenced guideline for the pharmacologic management of

substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol.

2012;26(7):899–952 (3)

Key Websites

Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results

from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series

H-50). Retrieved from http://www.samhsa.gov/data/. (4)

Alcoholic Anonymous. http://www.aa.org.

The National Institute on Alcohol Abuse and Alcoholism. http://www.niaaa.nih.gov.

Research Society on Alcoholism. http://www.rsoa.org.

ASAM Public Policy Statement on Treatment for Alcohol and Other Drug Addiction , Adopted: May 1, 1980,

Revised:January 1, 2010. http://www.asam.org/quality-practice/definition-of-addiction. (2)

COMPLETE REFERENCES CHAPTER 90 SUBSTANCE

ABUSE

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed.

Washington, DC: American Psychiatric Publishing; 2013.

ASAM Public Policy Statement on Treatment for Alcohol and Other Drug Addiction , Adopted May 1, 1980,

Revised January 1, 2010. http://www.asam.org/quality-practice/definition-of-addiction. Accessed

November 26, 2016.

Lingford-Hughes AR et al. BAP updated guidelines: evidenced guideline for the pharmacologic management of

substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol.

2012;26(7):899–952.

Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the

2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUHSeries H-50);

2015. http://www.samhsa.gov/data/. Accessed November 26, 2016.

Substance Abuse and Mental Health Administration, Office of Applied Studies. Results from the 2009 National

Survey on Drug Use and Health: Volume I. Summary of National Findings. Rockville, MD: Substance Abuse

and Mental Health Administration, US Dept of Health and Human Services; 2010. NSDUH Series H-38A,

HHS Publication No. SMA 10–4586Findings.

U.S. Department of Justice National Drug Intelligence Center National Drug Threat Assessment 2010. February

2010. https://www.justice.gov/archive/ndic/pubs38/38661/heroin.htm. Accessed January 31, 2017.

Inaba DS, Cohen WE. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. 6th

ed. Medford, OR: CNS Productions; 2007.

Savage SR, Horvath R. Opioid therapy of pain. In: Ries RK et al, eds. Principles of Addiction Medicine. 4th ed.

Philadelphia, PA: Lippincott Williams & Wilkins; 2009:1329.

Sullivan MD et al. Trends in opioid dosing among Washington State Medicaid patients before and after opioid

dosing guideline implementation. J Pain. 2016;17(5):561–568.

Garcia M et al. Implementation of an opioid management initiative by a state Medicaid program. J Manag Care

Pharm. 2014;20(5):447–454.

HIV and Injection Drug Use. HIV Surveillance Report 2016;27 http://www.cdc.gov/hiv/risk/idu.html.

Accessed November 26, 2016.

Ferguson R et al. Enterobacter agglomerans-associated cotton fever. Arch Intern Med. 1993;153(20):2381.

Deletoile A et al. Phylogeny and identification of Pantoea species and typing of Pantoea agglomerans strains by

multilocus gene sequencing. J Clin Microbiol. 2009;47(2):300.

Torka P, Gill S. Cotton fever: an evanescent process mimicking sepsis in an intravenous drug user. J Emerg Med.

2013;44(6):e385–e387.

Kleber HD et al. Treatment of patients with substance use disorders, second edition. American Psychiatric

Association. Am J Psychiatry. 2007;164(4 Suppl):5.

McAuley A et al. Exploring the life-saving potential of naloxone: a systematic review and descriptive metaanalysis of take home naloxone (THN) programmes for opioid users. Int J Drug Policy. 2015;26:1183–1188.

Rando J et al. Intranasal naloxone administration by police first responders is associated with decreased opioid

overdose deaths. Am J Emerg Med. 2015;33(9):1201–1204.

Schuckit MA. Treatment of opioid-use disorders. N EnglJ Med. 2016;375:357–368

Tetrault JM, O’Connor PG. Management of opioid intoxication and withdrawal. In: Ries RK et al, eds. Principles

of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:589.

Batki SL et al. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment

Improvement Protocol (TIP) Series 43. Rockville, MD: Center for Substance Abuse Treatment, Substance

Abuse and Mental Health Services Administration, US Dept of Health and Human Services; 2005. DHHS

Publication No. (SMA) 05–4048.

Amato L et al. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database Syst

Rev. 2005;(3):CD003409.

McNicholas L. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment

Improvement Protocol (TIP) Series 40. Rockville, MD: Center for Substance Abuse Treatment, Substance

Abuse and Mental Health Services Administration, US Department of Health and Human Services; 2004. HHS

Publication No. (SMA) 04–3939.

Gowing L et al. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2009;

(3):CD002025.

Gowing L et al. Alpha2-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst

Rev. 2009;(2):CD002024.

Collins ED et al. Anesthesia-assisted vs buprenorphine-or clonidine-assisted heroin detoxification and naltrexone

induction. JAMA. 2005;294(8):903.

Gowing L et al. Opioid antagonists under heavy sedation or anaesthesia for opioid withdrawal. Cochrane

Database Syst Rev. 2010;(1):CD002022.

Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Buprenorphine, Summary of Drug Addiction Treatment Act of 2000.

http://buprenorphine.samhsa.gov/titlexxxv.html. Accessed June 16, 2010.

Stine SM, Kosten TR. Pharmacologic interventions for opioid addiction. In: Ries RK et al, eds. Principles of

Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Wilkins & Williams; 2009:651.

Chou R et al. Methadone safety: a clinical practice guideline from the American Pain Society and College on

problems of drug dependence, in collaboration with the Heart Rhythm Society. J Pain. 2014;15(4):321–337.

Johnson RE et al. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence.

N EnglJ Med. 2000;343(18):1290.

Mattick RP et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.

Cochrane Database of Systematic Reviews 2014;(2):CD002207. doi:10.1002/14651858.CD002207.pub4.

Baxter JD et al. Factors associated with Medicaid patients’ access to buprenorphine treatment. J Sub Ab Treat.

2011;41:88–96.

Sullivan LE et al. The practice of office-based buprenorphine treatment of opioid dependence: is it associated with

new patients entering into treatment? Dug Alc Dep. 2005;76:113–116.

Rosenthal RN et al. Buprenorphine implants for treatment of opioid dependence: randomized comparison to

placebo and sublingual buprenorphine/naloxone. Addiction. 2013;108:2141–2149.

Soyka M. New developments in the management of opioid dependence: focus on sublingual buprenorphine–

naloxone. Subst Abuse and Rehab. 2015;6:1–14.

US Department of Justice, Drug Enforcement Administration, Office of Diversion Control. Drugs and Chemicals

of Concern: Buprenorphine, July 2013.

https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf Accessed January 31, 2017.

van Dorp E et al. Naloxone reversal of buprenorphine-induced respiratory depression. Anesthesiology. 2006;105

(1):51.

The Medical Letter. Naltrexone (Vivitrol)—a once-monthly injection for alcoholism. Med Lett Drugs Ther.

2006;48 (1240):63.

Earley PH. Physician health programs and addiction among physicians. In: Ries RK et al, eds. Principles of

Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:531.

National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective

medical treatment of opiate addiction. JAMA. 1998;280(22):1936.

Ebner N et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug

Alcohol Depend. 2007;87(2/3):131.

Jones HE et al. Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects

on the neonatal abstinence syndrome. Drug Alcohol Depend. 2005;79(1):1.

Lund IO et al. A comparison of buprenorphine and naloxone to buprenorphine and methadone in the treatment of

opioid dependence during pregnancy: maternal and neonatal outcomes. Subst Abuse: Res Treat. 2013;7:61–74

Kraft WK, van den Anker JN. Pharmacologic management of the opioid neonatal abstinence syndrome. Pedriatr

Clin N Am. 2012;59:1147–1165.

Jackson L et al. A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence

syndrome. Arch Dis Child Fetal Neonatal Ed. 2004;89(4):F300.

Osborn DA et al. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev.

2010;(10):CD002059.

Jansson LM et al. Methadone maintenance and lactation: a review of the literature and current management

guidelines. J Hum Lact. 2004;20(1):62.

Lindemalm S et al. Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact.

2009;25(2):199.

Ciraulo DA, Knapp CM. The pharmacology of nonalcoholsedative hypnotics. In: Ries RK et al, eds. Principles of

Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:99.

Dickinson WE, Eickelberg SJ. Management of sedative-hypnotic intoxication and withdrawal. In: Ries RK et al,

eds. Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:573.

Miller NS, Kipnis SS. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP)

Series 45. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health

Services Administration, US Department of Health and Human Services; 2006. HHS Publication No. (SMA)

06–4131.

Fatseas DC et al. Pharmacological interventions for benzodiazepine mono-dependence management in outpatient

settings. Cochrane Database Syst Rev. 2006;(3): CD005194.

Snead OC 3rd, Gibson KM. Gamma-hydroxybutyric acid [published correction appears in N Engl J Med.

2006;354(5):537]. N EnglJ Med. 2005;352(26):2721.

Gorelick DA. The pharmacology of cocaine, amphetamines, and other stimulants. In: Ries RK et al, eds.

Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:133.

Stefano GB et al. Nicotine, alcohol and cocaine coupling to reward processes via endogenous morphine signaling:

the dopamine-morphine hypothesis. Med Sci Monit. 2007;13(6):RA91.

Devlin RJ, Henry JA. Clinical review: major consequences of illicit drug consumption. Crit Care. 2008;12(1):202.

Wilkins JN et al. Management of stimulant, hallucinogen, marijuana, phencyclidine, and club drug intoxication and

withdrawal. In: Ries RK et al, eds. Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott

Williams & Wilkins; 2009:607.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning

Network, 2007: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Substance

Abuse and Mental Health Administration, US Dept of Health and Human Services; 2010.

McCord J et al. American Heart Association Acute Cardiac Care Committee of the Council on Clinical

Cardiology. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement

from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology.

Circulation. 2008;117(14):1897.

Turillazzi E et al. MDMA toxicity and pathological consequences: a review about experimental data and autopsy

findings. Curr Pharmaceutical Biotech. 2010;11(5):500–509.

Domino EF, Miller SC. The pharmacology of dissociatives. In: Ries RK, Fiellin DA, Miller SC, Saitz R, eds.

Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:231.

Caddy C et al. Ketamine and other glutamate receptor modulators for depression in adults. Cochrane Database

Syst Rev. 2015;(9):CD011612.

Glennon RA. The pharmacology of classical hallucinogens and related designer drugs. In: Ries RK et al, eds.

Principles of Addiction Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:215.

Pechinick RN et al, eds. Substance Abuse: A Comprehensive Textbook . 4th ed. Philadelphia, PA: Lippincott

Williams & Wilkins; 2005:313.

Halpern JH, Pope HG Jr. Hallucinogen persisting perception disorder: what do we know after 50 years? Drug

Alcohol Depend. 2003;69(2):109.

Grob CS, Poloand RE. MDMA. In: Lowinson JH et al, eds. Substance Abuse: A Comprehensive Textbook. 4th

ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:374.

Mithoefer M et al. The safety and efficacy of {+/–}3,4-methylenedioxymethamphetamine-associated

psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized

controlled pilot study. J Psychopharmacol. 2011;25(4):439–452.

Malberg JE, Bonson KR. How MDMA works in the brain. In: Holland J, ed. Ecstasy: The Complete Guide: A

Comprehensive Look at the Risks and Benefits of MDMA. Rochester, VT: Park Street Press; 2001:29.

Bravo GL. What does MDMA feel like? In: Holland J, ed. Ecstasy: The Complete Guide: A Comprehensive Look

at the Risks and Benefits of MDMA. Rochester, VT: Park Street Press; 2001:21.

Henry JA, Rella J. Medical risks associated with MDMA use. In: Holland J, ed. Ecstasy: The Complete Guide: A

Comprehensive Look at the Risks and Benefits of MDMA. Rochester, VT: Park Street Press; 2001:71.

Hall AP, Henry JA. Acute toxic effects of ’Ecstasy’ (MDMA) and related compounds: overview of

pathophysiology and clinical management. Br J Anaesth. 2006;96(6):678.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning

Network: Emergency Department Visits Involving PCP. November 12, 2013.

https://www.samhsa.gov/data/sites/default/files/DAWN143/DAWN143/sr143-emergencyphencyclidine-2013.htm Accessed January 31, 2017.

Baggott M, Mendelson J. Does MDMA cause brain damage? In: Holland J, ed. Ecstasy: The Complete Guide: A

Comprehensive Look at the Risks and Benefits of MDMA. Rochester, VT: Park Street Press; 2001:110.

Ben Amar M, Potvin S. Cannabis and psychosis: what is the link? J Psychoactive Drugs. 2007;39(2):131.

Welch SP. The pharmacology of cannabinoids. In: Ries RK et al, eds. Principles of Addiction Medicine. 4th ed.

Philadelphia, PA: Lippincott Williams & Wilkins; 2009:193.

Mechoulam R. Plant cannabinoids: a neglected pharmacological treasure trove. Br J Pharmacol. 2005;146(7):913.

Chong MS et al. Cannabis use in patients with multiple sclerosis. Mult Scler. 2006;12(5):646.

Center for Medicinal Cannabis Research, University of California. Report to the Legislature and Governor of the

State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding.

February 2010. http://www.cmcr.ucsd.edu/CMCRREPORT_FEB17.pdf. Accessed September 18, 2010.

Andrade C. Cannabis and neuropsychiatry, 2: the longitudinal risk of psychosis as an adverse effect. J Clin

Psychiatry. 2016;77(6):e739-e742

Martz ME, et al. Association of marijuana use with blunted nucleus accumbens response to reward anticipation.

JAMA Psychiatry. 2016;73(8):838–844.

Reece AS. Chronic toxicology of cannabis. Clin Toxicol 2009;47:517–524.

Pope HG Jr et al. Neuropsychological performance in long-term cannabis users. Arch Gen Psychiatry.

2001;58(10):909.

Simpson AK, Magid V. Cannabis use disorder in adolescence. Child Adolesc Psychiatric Clin N Am.

2016;25:431–443.

Moore THM, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.

Lancet. 2007;370:319–328.

Meier MH, et al. Associations between cannabis use and physical health problems in early midlife. A longitudinal

comparison of persistent cannabis vs tobacco users. JAMA Psychiatry. 2016;73(7):731–740.

Tetrault JM et al. Effects of marijuana smoking on pulmonary function and respiratory complications: a systematic

review. Arch Intern Med. 2007;167(3):221.

Tashkin DP. Airway effects of marijuana, cocaine, and other inhaled illicit agents. Curr Opin Pulm Med.

2001;7(2):43.

Szyper-Kravitz M et al. Early invasive pulmonary aspergillosis in a leukemia patient linked to aspergillus

contaminated marijuana smoking. Leuk Lymphoma. 2001;42(6):1433.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Patterns and Trends in

Inhalant Use by Adolescent Males and Females: 2002–2005. The National Survey on Drug Use and Health

Report. Rockville, MD: Office of Applied Studies, Substance Abuse and Mental Health Services

Administration, US Dept of Health and Human Services; 2007.

National Institute on Drug Abuse, Research Report Series. Inhalant Abuse. Rockville, MD: National Institute on

Drug Abuse, US Dept of Health and Human Services; 2005. NIH Pub. No. 05–3818.

Johnston LD et al. Monitoring the Future: National Results on Adolescent Drug Use: Overview of Key Findings,

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

2009. Bethesda, MD: National Institute on Drug Abuse. 2010. NIH Pub. No. 10–7583.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Characteristics of

Recent Adolescent Inhalant Initiates. Rockville, MD: National Survey on Drug Use and Health, Substance

Abuse and Mental Health Services Administration, US Dept of Health and Human Services. 2006. The

NSDUH Report, Issue 11.

Balster RL. The pharmacology of inhalants. In: Ries RK et al, eds. Principles of Addiction Medicine. 4th ed.

Philadelphia, PA: Lippincott Williams & Wilkins; 2009:241.

Riegel AC et al. The abused inhalant toluene increases dopamine release in the nucleus accumbens by directly

stimulating ventral tegmental area neurons. Neuropsychopharmacology. 2007;32(7):1558.

Heath DB, ed. International Handbook on Alcohol and Culture. Westport, CT: Greenwood Press; 1995.

Bardon S. Brewed in America: A History of Beer and Ale in the United States. Boston, MA: Little Brown; 1962.

Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results

of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol. 1997;58:464.

Regier DA et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA. 1990;264:2511.

Kenna GA et al. Pharmacotherapy, pharmacogenomics and the future of alcohol dependence treatment. Part 2.

Am J Health Syst Pharm. 2004;61:2380.

Kranzler HR, Edenberg HJ. Pharmacogenetics of alcohol and alcohol dependence treatment. Curr Pharm Des.

2010;16:2141.

Cherpitel CJ et al. The effect of alcohol consumption on emergency department services use among injured

patients: a cross-national emergency room study. J Stud Alcohol. 2006;67:890.

Cox RG et al. Academic performance and substance use: findings from a state survey of public high school

students. J Sch Health. 2007;77:109.

Thun MJ et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med.

1997;337:1705.

Zakhari S. Alcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action.

Alcohol Health Res World. 1997;21:21.

Mukamal KJ et al. Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles. Arch

Intern Med. 2006;166:2145.

Mukamal KJ et al. Binge drinking and mortality after acute myocardial infarction. Circulation. 2005;112:3839.

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health.

2nd ed. Washington, D.C.: US Government Printing Office; 2000.

Fillmore KM et al. Alcohol consumption and mortality. I. Characteristics of drinking groups. Addiction.

1998;93:183.

Magrone T et al. Red wine consumption and prevention of atherosclerosis: an in vitro model using human

peripheral blood mononuclear cells. Curr Pharm Des. 2007; 13:3718.

Agarwal DP. Cardioprotective effects of light-moderate consumption of alcohol: a review of putative

mechanisms. Alcohol. 2002;37:409.

David DJ, Spyker DA. The acute toxicity of ethanol: dosage and kinetic nomograms. Vet Hum Toxicol.

1979;21:272.

Oneta CM et al. First pass metabolism of ethanol is strikingly influenced by the speed of gastric emptying. Gut.

1998;43:612.

Jones AW et al. Effect of high-fat, high-protein, and high-carbohydrate meals on the pharmacokinetics of a small

dose of ethanol. Br J Clin Pharmacol. 1997;44:521.

Pihl RO et al. Alcohol affects executive cognitive functioning differentially on the ascending versus descending

limb of the blood alcohol concentration curve. Alcohol Clin Exp Res. 2003;27:773.

Swift R. Direct measurement of alcohol and its metabolites. Addiction. 2003;98(Suppl 2):73.

Wilkinson PK et al. Blood ethanol concentrations during and following constant-rate intravenous infusion of

alcohol. Clin Pharmacol Ther. 1976;19:213.

Hammond KB et al. Blood ethanol: a report of unusually high levels in a living patient. JAMA. 1973;226:63.

DiPadova C et al. Effects of fasting and chronic alcohol consumption on the first-pass metabolism of ethanol.

Gastroenterology. 1987;92:1169.

Ammon E et al. Disposition and first-pass metabolism of ethanol in humans: is it gastric or hepatic and does it

depend on gender? Clin Pharmacol Ther. 1996;59:503.

Levitt MD, Levitt DG. The critical role of the rate of ethanol absorption in the interpretation of studies purporting

to demonstrate gastric metabolism of ethanol. J Pharmacol Exp Ther. 1994;269:297.

121.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

138.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Levitt MD et al. Use of measurements of ethanol absorption from stomach and intestine to assess human

ethanol metabolism. Am J Physiol. 1997;273:G951.

Lieber CS. Ethnic and gender differences in ethanol metabolism. Alcohol Clin Exp Res. 2000;24:417.

Franke A et al. Alcohol-related diseases of the esophagus and stomach. Dig Dis. 2005;23:204.

Lands WE. A review of alcohol clearance in humans. Alcohol. 1998;15:147.

Crabb DW et al. Alcohol sensitivity, alcohol metabolism, risk of alcoholism, and the role of alcohol and aldehyde

dehydrogenase. J Lab Clin Med. 1993;122:234.

Kopun M, Propping P. The kinetics of ethanol absorption and elimination in twins and supplementary repetitive

experiments in singleton subjects. Eur J Clin Pharmacol. 1977;11:337.

AdachiJ et al. Comparative study on ethanol elimination and blood acetaldehyde between alcoholics and control

subjects. Alcohol Clin Exp Res. 1989;13:601.

Lieber CS. Alcoholic fatty liver: its pathogenesis and mechanism of progression to inflammation and fibrosis.

Alcohol. 2004;34:9.

Lieber CS. Metabolism of alcohol. Clin Liver Dis. 2005;9(1):1–35.

DeFeo P et al. Ethanol impairs post-prandial hepatic protein metabolism. J Clin Invest. 1995;95:1472.

Eriksson CJP. The role of acetaldehyde in the actions of alcohol (update 2000). Alcohol Clin Exp Res. 2001;25

(5 Suppl ISBRA):15S.

O’Shea RS et al. Practice Guideline Committee of the American Association for the Study of Liver Diseases;

Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease.

Hepatology. 2010;51:307.

Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug

Use and Health: National Findings. Rockville, MD: Office of Applied Studies; 2008. NSDUH Series H-34,

HHS Publication No. SMA 8-4343.

Suzdak PD et al. Ethanol stimulates gamma-aminobutyric acid receptor-mediated chloride transport in rat brain

synaptoneurosomes. Proc Natl Acad Sci USA. 1986;83:4071.

Kumar S et al. The role of GABA(A) receptors in the acute and chronic effects of ethanol: a decade of

progress. Psychopharmacology (Berl). 2009;205:529.

Vengeliene V et al. Neuropharmacology of alcohol addiction. Br J Pharmacol. 2008;154:299.

Nagy J. Changes in regulation of NMDA receptor functions. Curr Neuropharmacol. 2008;6:39.

Nestler EJ et al. Second messenger and protein phosphorylation mechanisms underlying possible genetic

vulnerability to alcoholism. Ann N Y Acad Sci. 1994;708:108.

Basavarajappa BS, Hungund BL. Neuromodulatory role of the endocannabinoid signaling system in alcoholism:

an overview. Prostaglandins Leukot Essent Fatty Acids. 2002;66:287.

Koob GF, Weiss F. Neuropharmacology of cocaine and ethanol dependence. Recent Dev Alcohol. 1992;10:201.

Söderpalm B, Löf E, Ericson M. Mechanistic studies of ethanol’s interaction with the mesolimbic dopamine

reward system. Pharmacopsychiatry. 2009;42(Suppl 1):S87.

Wise RA, Bozarth MA. A psychomotor stimulant theory of addiction. Psychol Rev. 1987;94:469.

Robinson TE, Berridge KC. The neural basis of drug craving: an incentive-sensitization theory of addiction.

Brain Res Brain Res Rev. 1993;18:247.

Volkow ND, Li T-K. Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci. 2004;5:963.

Koob GF, Volkow ND. Neurocircuitry of addiction [published correction appears in Neuropsychopharmacology.

2010;35:1051]. Neuropsychopharmacology. 2010;35:217.

Chao J, Nestler EJ. Molecular neurobiology of drug addiction. Annu Rev Med. 2004;55:113.

Melgaard B. The neurotoxicity of ethanol. Acta Neurol Scand. 1983;67:131.

Kupari I et al. Acute effects of alcohol, beta blockade and their combination on left ventricular function and

hemodynamics in normal man. Eur Heart J. 1983;4:463.

Michiels TM et al. Naloxone reverses ethanol induced depression of hypercapnic drive. Am Rev Respir Dis.

1983; 128:823.

O’Neill S et al. Survival after high blood alcohol levels. Association with first-order elimination kinetics. Arch

Intern Med. 1984;144:641.

Maldonado JR. An approach to the patient with substance use and abuse. Med Clin North Am. 2010;94:1169, xi.

Poikolainen K. Estimated lethal ethanol concentrations in relation to age, aspiration, and drugs. Alcohol Clin Exp

Res. 1984;8:223.

Golan D et al. The Principles of Pharmacology. The Pathophysiologic Basis of Drug Therapy. 2nd ed.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

185.

186.

Baltimore, MD: Lippincott Williams & Wilkins; 2008:171.

Jones AW, Hahn RG. Pharmacokinetics of ethanol in patients with renal failure before and after hemodialysis.

Forensic Sci Int. 1997;90:175.

Kozak LJ et al. National Hospital Discharge Survey: 2000 annual summary with detailed diagnosis and

procedure data. Vital Health Stat 13. 2000;(153):1.

Finn DA, Crabbe JC. Exploring alcohol withdrawalsyndrome. Alcohol Health Res World. 1997;21:149.

Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N EnglJ Med. 2003;348:1786.

Spies CD, Rommelspacher H. Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth

Analg. 1999;88:946.

Trevisan LA et al. Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World.

1998; 22:61.

Asplund CA et al. 3 regimens for alcohol withdrawal and detoxification. J Fam Pract. 2004;53:545.

Sullivan JT et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for

alcoholscale (CIWA-Ar). Br J Addict. 1989;84:1353.

Riker RR et al. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care

Med. 1999;27:1325.

Schatzberg AF et al. Manual of Clinical Psychopharmacology. 7th ed. Washington, D.C.: American Psychiatric

Publishing; 2010.

Lejoyeux M et al. Benzodiazepine treatment for alcohol-dependent patients. Alcohol. 1998;33:563.

Hillbom M et al. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS

Drugs. 2003;17:1013.

Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on

symptoms and cognitive recovery. Drug Alcohol Depend. 1986;18:329.

Kraemer KL et al. Managing alcohol withdrawal in the elderly. Drugs Aging. 1999;14:409.

Perry EC. Inpatient management of acute alcohol withdrawalsyndrome. CNS Drugs. 2014;28:401–410.

Carlson RW, et al. Alcohol withdrawalsyndrome. Crit Care Clin. 2012;28:549–585.

Bayard M et al. Alcohol withdrawalsyndrome. Am Fam Physician. 2004;69:1443.

Cook CC et al. Vitamin B deficiency and neuropsychiatric syndromes in alcohol misuse. Alcohol. 1998;33:317.

Isenberg-Grzeda E, et al. Wernicke-Korsakoff-Syndrome: Under-recognized and under-treated.

Psychosomatics. 2012;53:507–516.

Sellers EM et al. Comparative efficacy of propranolol and chlordiazepoxide in alcohol withdrawal. J Stud

Alcohol. 1977;38:2096.

Horwitz RI et al. The efficacy of atenolol in the outpatient management of the alcohol withdrawal syndrome.

Results of a randomized clinical trial. Arch Intern Med. 1989; 149:1089.

Baumgartner GR, Rowen RC. Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal

syndrome. Arch Intern Med. 1987;147:1223.

Mayo-Smith MF et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch

Intern Med. 2004;164:1405.

Vinson DC et al. Comfortably engaging: which approach to alcohol screening should we use? Ann Fam Med.

2004;2:398.

Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252:1905.

Saunders JB et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative

Project on Early Detection of Persons with Harmful Alcohol Consumption. II. Addiction. 1993;88:791.

Garbutt JC et al. Pharmacological treatment of alcohol dependence: a review of the evidence. JAMA.

1999;281:1318.

Fuller RK et al. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. JAMA. 1986;

256:1449.

O’Malley S et al. Naltrexone and coping skills therapy for alcohol dependence. Arch Gen Psychiatry.

1992;49:881.

VolpicelliJR et al. Naltrexone in the treatment of alcoholism. Arch Gen Psychiatry. 1992;49:876.

Sass H et al. Relapse prevention by acamprosate. Results from a placebo controlled study on alcohol

dependence. Arch Gen Psychiatry. 1996;53:673.

Pelc I et al. Efficacy and safety of acamprosate in the treatment of detoxified alcohol-dependent patients. A 90-

day placebo-controlled dose finding study. Br J Psychiatry. 1997;171:73.

Kranzler HR et al. Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. Am J

187.

188.

189.

.

.

192.

193.

194.

195.

196.

197.

.

199.

200.

201.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Psychiatry. 1995;152:391.

Cornelius JR et al. Fluoxetine in depressed alcoholics. A double-blind placebo controlled trial. Arch Gen

Psychiatry. 1997;54:700.

Pettinati H et al. Sertraline treatment for alcohol dependence. Interactive effects of medication and alcoholic

subtype. Alcohol Clin Exp Res. 2000;24:1041.

Johnson BA et al. Ondansetron for reduction of drinking among biologically predisposed patients: a randomized

controlled trial. JAMA. 2000;284:963.

Johnson BA et al. Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet.

2003; 361:1677.