Journal of addictive diseases
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This is a review of the most current thinking on physician impairment with regard to definitions, prevalence, etiology, diagnosis, detection, intervention, treatment, treatment outcomes and prevention. The impaired physicians movement needs to be concerned with what is effective.
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Review
The epidemiology of the comorbidity of psychiatric and addictive disorders: a critical review.
Assessing the prevalence of the comorbidity of psychiatric and addictive disease using epidemiologic methods results in artifactually high rates. Use of a clinical sample will yield falsely high rates, because substance use is associated with exacerbation of mental illness. Cross sectional design will inflate rates of psychiatric comorbidity in addicts, who attribute substance use to psychological symptoms until well into recovery. ⋯ The psychiatric symptoms which are common in active addiction generally clear within weeks to months of treatment for addiction but do not respond to standard psychopharmacologic treatment for primary mental illness. When lengthy follow up periods are employed, substance induced psychiatric syndromes typically resolve. We conclude that while patients treated in psychiatric settings often have comorbid and independent addictive illness, patients treated in addiction settings uncommonly have comorbid psychiatric illness despite common psychiatric symptoms.
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In the 1980s, the clandestine synthesis, distribution, and use of analogs of controlled substances became popular in the United States. These designer drugs comprise analogs of many different classes of psychoactive drugs and present a spectrum of adverse health effects ranging from mood changes to severe neurologic disease. Although there has been no unified program of surveillance for these drugs, a number of articles describing their presence in North American communities have appeared in a variety of publications. This paper summarizes the evidence of designer drug production and use, and recommends effective surveillance efforts that might be adopted by drug abuse prevention and public health agencies.