ADDICTION TREATMENT; PERSONAL CHARACTERISTICS
In planning and implementing treatment, a clinician should consider several variables with regard to patients: comorbid psychiatric and general medical conditions, gender-related factors, age, social milieu and living environment, cultural factors, gay/lesbian/bisexual/transgender issues, and family characteristics. Given the high prevalence of comorbidity of substance use disorders and other psychiatric disorders, the diagnostic distinction between substance use symptoms and those of other disorders should receive particular attention, and specific treatment of comorbid disorders should be provided. In addition to pharmacotherapies specific to a patient's substance use disorder, various psychotherapies may also be indicated when a patient has a co-occurring psychiatric disorder, psychosocial stressors, or other life circumstances that exacerbate the substance use disorder or interfere with treatment. A patient's cessation of substance use may also be associated with changes in his or her psychiatric symptoms or the metabolism of medications (e.g., altered antipsychotic metabolism via cytochrome P450 1A2 with smoking cessation) that will necessitate adjustment of psychotropic medication doses.
In women of childbearing age, the possibility of pregnancy needs to be considered. Each of the substances discussed in this practice guideline has the potential to affect the fetus, and psychosocial treatment to encourage substance abstinence during pregnancy is recommended. With some substances, concomitant agonist treatment may be preferable to continued substance use. In pregnant smokers, treatment with nicotine replacement therapy (NRT) may be helpful [II]. For pregnant women with an opioid use disorder, treatment with methadone or buprenorphine [II] can be a useful adjunct to psychosocial treatment.
Los Angeles and Orange County Gay, Lesbian, Bisexual Transgender and cultural
minority communities seek treatment at programs which are gay friendly or culturally informed/
sensitive.
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