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In the Clinic |

Substance Use Disorders

Christine A. Pace, MD, MSc; and Jeffrey H. Samet, MD, MA, MPH
[+] Article, Author, and Disclosure Information

CME Objective: To review current evidence for epidemiology, prevention, diagnosis, complications, and management of substance use disorders.

Funding Source: American College of Physicians.

Acknowledgment: The authors thank Julia Canfield, MPH; Dan Alford, MD, MPH; Lee Ellenberg, LICSW; David Fiellin, MD; Tim Naimi, MD, MPH; Richard Saitz, MD, MPH; and Alexander Walley, MD, MSc for their assistance.

With the assistance of additional physician writers, the editors of Annals of Internal Medicine develop In the Clinic using MKSAP and other resources of the American College of Physicians.

In the Clinic does not necessarily represent official ACP clinical policy. For ACP clinical guidelines, please go to https://www.acponline.org/clinical_information/guidelines/.

Disclosures: Dr. Pace and Dr. Samet, ACP Contributing Authors, have disclosed no conflicts of interests. Forms can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2657.


Ann Intern Med. 2016;164(7):ITC49-ITC64. doi:10.7326/AITC201604050
© 2016 American College of Physicians
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This issue provides a clinical overview of substance use disorders, focusing on epidemiology, prevention, diagnosis, complications, and management. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

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Tobacco plus other Substance Use Disorders: leaping the chasm in two jumps
Posted on April 22, 2016
Alain Braillon , MD
University Hospital, Amiens, France
Conflict of Interest: None Declared
Why tobacco is excluded from the CME about Substance Use Disorders (SUD)?(1) Only two sentences with low expectations, without references: “Finally, physicians should address tobacco use in patients with substance use disorders, just as they would with other patients. Tobacco is a major cause of morbidity and mortality among patients who are actively using drugs and alcohol, as well as those in recovery; no evidence convincingly suggests that tobacco cessation worsens substance use outcomes or causes relapse.”(1)
Robust evidence has been available since 2004. A systematic review of 17 studies showed tobacco cessation treatment does not compromise other SUD treatment and does improve other substance uses (alcohol and illicit drugs) outcomes, predicting more favourable long-term outcomes.(2) This is confirmed by more recent studies.(3-4) Even during acute state, nicotine replacement therapy allows to reduce agitation and aggression in patients with severe mental disorders.(5)
Having low expectations about smoking cessation treatment is flying in the face of evidence and a reminder of the paternalistic nature of too much of medicine’s past, it harms the most vulnerable.

The most dangerous thing in the world is to leap a chasm in two jumps.(David Lloyd George, British Prime Minister during World War I)

1 Pace CA, Samet JH. Substance Use Disorders. Ann Intern Med 2016 5;164:ITC49-ITC64.
2 Prochaska J J, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol 2004;72: 1144-1156.
3 Mannelli P, Wu LT, Peindl KS, Gorelick DA. Smoking and opioid detoxification: behavioral changes and response to treatment. Nicotine Tob Res 2013;15:1705-13.
4 Weinberger AH, Platt J, Jiang B, Goodwin RD. Cigarette smoking and risk of alcohol use relapse among adults in recovery from alcohol used. Alcohol Clin Exp Res 2015;39:1989-96.
5 Allen MH, Debanné M, Lazignac C, Adam E, Dickinson LM, Damsa C. Effect of nicotine replacement therapy on agitation in smokers with schizophrenia: a double-blind, randomized, placebo-controlled study. Am J Psychiatry 2011;168:395-9
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